Which of the following is the most pathognomonic sign of impending burst abdomen: March 2008

Ans. D: Serosanguinous discharge Abdomen is likely to burst if: It is swollen for any reason, such as ileus, intestinal obstruction, or a large tumour. Severe intra-abdominal sepsis, such as an infected Caesarean section, typhoid peritonitis, or a perforation of his large gut. Suturing of abdomen with catgut or some other absorbable suture, especially of low quality or out of date, or if abdominal wound becomes infected. Suturing in layers, taking bites of tissue that are too small. Patient is having carcinomatosis, uraemia, or obstructive jaundice. An abdomen will almost never burst if: It is sutured with a non-absorbable suture, such as steel, nylon, or polyethylene. Close its muscles with one layer of through-and-through sutures, which are not too tight and with wide bites of tissue. Use delayed skin suture if the wound is infected or potentially so. The three main post-operative causes are abdominal distension, intestinal leakage and wound infection. Leakage is impoant as it will nearly always lead to wound disruption. A serosanguinous (pink) discharge from the wound is forerunner of disruption in 50% of cases. It is the most pathognomonic sign of impending wound disruption and it signifies that intraperitoneal contents are lying extraperitoneally.