Characteristics of patients with post caesarean section burst abdomen and its treatment outcome at Muhimbili National Hospital

Abstract

Background: Burst abdomen is a distressing complication and remains a major cause of morbidity following any abdominal surgery whether elective or emergency. There are many factors responsible for burst abdomen. Anaemia is among others that play a significant role in causing burst abdomen. Owing to high rates of cesarean section, different post surgical complications including burst abdomen are encountered in post CS patients at MNH. Objective: The objective of this study was to describe the characteristics of patients with burst abdomen and its treatment outcome among patients who underwent CS at MNH. Methodology: This was a case series study conducted from 22ndJuly 2016 to 22ndJanuary2017 among patients who underwent CS at MNH and developed burst abdomen. Patients were recruited in obstetric wards after they had met the inclusion criteria and had consented. They were then followed up until the first follow up visit (two weeks) after being discharged home. Data on socio-demographic characteristics, patient’s medical history, physical examination, laboratory investigations, and surgical procedure were obtained from patients and their files using a structured questionnaire and a checklist. Data was analyzed using SPSS version 20 software and results presented as means and proportions. Results A total of 12 patients who underwent CS at MNH and developed burst abdomen were studied. During the study period, a total of 2768 CS were done at MNH (an average of 461 CS per month) of which12 developed burst abdomen. This is an average of 2 cases every month with a frequency of about 4.3 per 1000 patients who had undergone CS at MNH. The mean age of the studied patients was 26.7years. On average burst abdomen was reported on the 5th day post CS. Most patients were operated as emergency (10 patients) while 2 were elective cases. SUMI was the most used abdominal incision (10 patients) while Pfannenstiel incision was used in 2 patients. The duration of hospital stay ranged from 7-35days with a mean duration of 23.1 days. There was no death among the studied patients.

Conclusion Burst abdomen is said to have occurred when there is disruption of the layers of an abdominal wound including the rectus sheath or herniation of peritoneal contents through a gap in the rectus sheath, eviscereation of peritoneal contents and serosanguinous discharge. The frequency of burst abdomen is about 4.3 per 1000 patients who had undergone CS at MNH. Results of this study suggest that patients who develop burst abdomen may have clinical cor-morbidities such as anaemia, pre-eclampsia and eclampsia, PROM and obstructed labour. Surgery related characteristics such as experience of the surgeon, type of incision, use of pre and post operative antibiotics have a role to play for a good outcome of a post CS wound. Some patients with post CS burst abdomen may have STAH done even before completion of their families. It is a fact that patients with post CS burst abdomen have a prolonged hospital stay.

Recommendation A large study of a different design is needed in order to find out the statistical association between different causative factors for burst abdomen.