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# Wound dehiscence and evisceration

Wound dehiscence is when a surgical cut reopens. If the deep layer gives way and the bowel comes out (evisceration), it is a surgical emergency.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Linea alba](https://durgical.com/en/anatomy/linea-alba/)
- [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/)
- [Skin](https://durgical.com/en/anatomy/skin/)
- [Rectus sheath](https://durgical.com/en/anatomy/rectus-sheath/)
- [External oblique](https://durgical.com/en/anatomy/external-abdominal-oblique-muscle/)
- [Transversus abdominis](https://durgical.com/en/anatomy/transversus-abdominis-muscle/)
- [Peritoneum](https://durgical.com/en/anatomy/peritoneum/)
- [Greater omentum](https://durgical.com/en/anatomy/greater-omentum/)
- [Jejunum](https://durgical.com/en/anatomy/jejunum/)
- [Ileum](https://durgical.com/en/anatomy/ileum/)

## Why it happens

- [What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow](https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/)
- [Healing of skin wounds: first and second intention](https://durgical.com/en/general-pathology/healing-of-skin-wounds-first-and-second-intention/)
- [Granulation tissue and scar formation](https://durgical.com/en/general-pathology/granulation-tissue-and-scar-formation/)
- [Abnormal repair: chronic wounds, hypertrophic scar, keloid, contracture](https://durgical.com/en/general-pathology/abnormal-repair-chronic-wounds-hypertrophic-scar-keloid-contracture/)
- [Collagen synthesis](https://durgical.com/en/biochemistry/topics/collagen-synthesis/)
- [Wound healing: phases and scar](https://durgical.com/en/histology/wound-healing-phases-and-scar/)

## What it is

Partial or complete separation of the layers of a closed surgical wound, most important after midline laparotomy. Fascial dehiscence (burst [abdomen](https://durgical.com/en/anatomy/region/abdomen/)) is the opening of the deep closure; evisceration is the protrusion of abdominal contents, usually omentum or small bowel, through the open wound.

## Who gets it

Abdominal fascial dehiscence follows roughly 0.5–3% of laparotomies, more often after emergency surgery, and carries substantial mortality. It usually appears 5–10 days after surgery. In Colombia, emergency laparotomies for trauma and peritonitis and the rising prevalence of obesity and diabetes keep it a relevant problem.

## Causes

- Technical factors: suture breakage, knot slippage or sutures cutting through the fascia
- Surgical site infection
- Raised intra-abdominal pressure: coughing, vomiting, ileus, ascites, straining
- Impaired healing of the tissues

## Risk factors

- Emergency surgery and midline incisions
- Wound infection
- Obesity
- Malnutrition and low albumin
- Diabetes, smoking and chronic lung disease
- Older age, anaemia, uraemia, cancer and corticosteroid use
- Stoma brought out through the wound

## Pathophysiology

Fascia regains strength slowly and depends on sutures during the first weeks. When tension from rising abdominal pressure exceeds the hold of the sutures, or infection and poor collagen synthesis weaken the edges, the fascia separates. The skin may still be closed at first, hiding the defect, until abdominal contents push through.

## Classification

- Superficial dehiscence (skin and subcutaneous tissue) versus deep fascial dehiscence
- Partial versus complete
- With or without evisceration

## Symptoms and signs

- Sudden gush of serosanguinous (salmon-pink) fluid from the wound, often the first sign
- A feeling that something has popped or given way, often after coughing or straining
- Gaping wound edges
- Bowel or omentum visible in the wound (evisceration)
- Signs of wound infection: redness, warmth, pus, fever

## Red flags

- Visible bowel or omentum in the wound
- Serosanguinous discharge from a midline wound around postoperative days 5–10
- Signs of shock or peritonitis
- Dusky or dark exposed bowel (ischaemia)

## Diagnosis

**Clinical**
Clinical: inspection and gentle examination of the wound show separation of the edges and whether the fascia is intact or bowel is exposed.

**Tests**
Full blood count, inflammatory markers, albumin, glucose and wound cultures when infection is suspected.

**Imaging**
Usually not needed; CT can show a fascial defect hidden under intact [skin](https://durgical.com/en/anatomy/skin/) and detect intra-abdominal abscess or anastomotic leak.

## Differential diagnosis

- Superficial wound separation with intact fascia
- Surgical site infection or seroma
- Wound haematoma
- Early incisional hernia
- Anastomotic leak with an enterocutaneous fistula

## Goal of treatment

Protect exposed viscera, close or manage the abdominal wall safely, treat the cause (infection, high pressure, poor nutrition) and prevent incisional hernia.

## Treatment

**Acute**
For evisceration: stay with the patient, call the surgical team, cover the exposed contents with sterile dressings soaked in warm sterile saline, place the patient supine with knees flexed to reduce wall tension, keep nil by mouth and monitor vital signs. Exposed bowel is never pushed back in.

**Surgical**
Return to the operating room for fascial closure under general anaesthesia, with removal of necrotic tissue and treatment of infection; when closure is not possible, temporary abdominal closure or mesh is used.

**Conservative**
Superficial dehiscence with intact fascia is managed with local wound care, healing by secondary intention or with negative-pressure wound therapy.

**Medical**
Antibiotics when infection is present, nutritional support and correction of glucose and anaemia.

**Follow-up**
Nursing priorities: daily wound assessment, splinting the incision with a pillow during coughing, controlling vomiting and constipation, and recognising serosanguinous drainage early.

## Complications

- Evisceration and bowel injury or ischaemia
- Peritonitis and sepsis
- Enteroatmospheric or enterocutaneous fistula
- Incisional hernia
- Prolonged hospital stay and death

## Prognosis

Superficial dehiscence usually heals with wound care. Fascial dehiscence carries significant mortality, mainly from the underlying illness and sepsis, and many survivors later develop an incisional hernia.

## Prevention

- Careful fascial closure technique, such as continuous small-bite suturing
- Prevention of surgical site infection
- Optimising nutrition, glucose control and stopping smoking before elective surgery
- Controlling cough, vomiting and abdominal distension after surgery

## Test yourself

Think of the answer, then tap the question to see it.

## What is often the first sign of abdominal fascial dehiscence?

A sudden gush of serosanguinous (salmon-pink) fluid from the wound.

## When does abdominal wound dehiscence most often occur?

Around postoperative days 5–10.

## What is the nursing priority when evisceration is found?

Cover the exposed viscera with sterile saline-moistened dressings, position with knees flexed, stay with the patient and call the surgeon.

## Should eviscerated bowel be reinserted at the bedside?

No; it is covered and protected while the patient is prepared for surgery.

## Which two risk factors are most strongly linked to wound dehiscence?

Surgical site infection and obesity, together with emergency surgery and poor nutrition.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/wound-dehiscence-and-evisceration/)

## Related conditions

- [Surgical site infection](https://durgical.com/en/conditions/surgical-site-infection/)
- [Incisional (ventral) hernia](https://durgical.com/en/conditions/incisional-hernia/)
- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Necrotizing soft tissue infection (necrotizing fasciitis, gas gangrene)](https://durgical.com/en/conditions/necrotizing-soft-tissue-infection/)
- [Postoperative ileus](https://durgical.com/en/conditions/postoperative-ileus/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Abdominal Wound Dehiscence: A Review of Risk Factors, Prevention and Management in Obstetrics and Gynecology Practice](https://ojs.uph.edu/index.php/MED/article/view/3767) (Medicinus, 2021).

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Source: https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/