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General Surgery · Abdominal wall: burst abdomen
Sample itemOn the 8th day after emergency laparotomy for perforation, a patient has a copious salmon-pink serous discharge from the midline wound, with the skin still intact. What is the most appropriate management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Return to theatre for re-closure of the fascia under general anaesthesia
A sudden discharge of serosanguinous peritoneal fluid from a wound around days 7 to 10 warns of fascial dehiscence. The skin is covered with a saline dressing and the patient is returned to theatre for re-suturing, with correction of risk factors such as sepsis, malnutrition and cough. Evisceration is an emergency.
Option by option
A. Apply an abdominal binder and discharge
A binder and discharge delay treatment and risk evisceration at home.
B. Oral antibiotics and observation
Antibiotics do not address the failing fascial layer.
C. Return to theatre for re-closure of the fascia under general anaesthesia (correct)
Correct. The discharge signals impending fascial failure, so urgent re-closure is needed.
D. Remove skin sutures at the bedside
Removing skin sutures at the bedside risks evisceration.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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