Evisceration (Abdominal Organs Through a Wound)

First aid for evisceration

1. Call 911 or your local emergency number. Keep the person lying on their back.
2. Do not touch or push the organs back into the abdomen. This can cause injury and infection.
3. Cover the organs with a clean, moist dressing: sterile gauze or a clean cloth soaked in sterile saline or clean water. Then cover loosely with plastic wrap or foil to retain moisture and warmth, if available.
4. Bend the knees slightly (a pillow or rolled blanket underneath) to relax the abdominal muscles, unless there is a suspected spine injury.
5. Control bleeding from the wound edges with gentle pressure around, not on, the exposed organs.
6. Keep the person warm and still, and reassure them.
7. Do not give food or drink.
8. Leave any impaled object in place; pad around it to stop it moving.
9. Watch for shock and be ready to start CPR if breathing stops.

Causes

Traumatic evisceration

• stab wounds and lacerations
• gunshot wounds
• blast injuries
• impalement
• severe crush or shearing injuries, including farm and machinery accidents

See abdominal trauma.

Surgical wound evisceration

After abdominal surgery, the layers of the wound are closed separately. If the deep, strong fascial layer fails, the wound can split open (wound dehiscence). If it is a complete separation, organs can push through. This usually happens 5 to 10 days after surgery, before the wound has gained strength, and is often triggered by a sudden rise in abdominal pressure from coughing, vomiting, straining or sneezing. A classic warning sign is a sudden discharge of salmon-pink, watery fluid from the wound.

In newborns

Gastroschisis is a birth defect in which the bowel protrudes through a hole beside the belly button. It is a different condition but managed with similar protective principles before surgery.

Risk factors for surgical evisceration

• obesity
• diabetes
• smoking
• malnutrition and low protein levels
• steroid or immune-suppressing medicines
• wound infection (surgical site infection)
• chronic cough, vomiting, constipation or straining
• ascites (fluid in the abdomen)
• emergency surgery, long midline incisions, and previous surgery through the same scar
• older age, cancer and kidney failure

Dehiscence vs evisceration

Hospital treatment

1. Resuscitation: IV fluids, blood if needed, oxygen and pain relief.
2. Protecting the organs with sterile, moist dressings.
3. Antibiotics to prevent infection.
4. Emergency surgery: the surgeon examines the bowel and other organs for damage or loss of blood supply, washes out the abdomen, repairs injuries and closes the abdominal wall. Sometimes the abdomen is left temporarily open with a special dressing and closed in stages, or closed with mesh.
5. Post-operative care: abdominal binders, cough support, nutrition, managing blood sugar, and treatment of the original cause such as infection.

Complications

• infection and peritonitis
• injury or loss of blood supply to the bowel
• fistulas (abnormal connections between bowel and skin)
• incisional hernia later
• shock and organ failure in severe trauma
• death, particularly with major trauma or in frail patients

Preventing surgical wound breakdown

• Stop smoking before planned surgery.
• Control blood sugar.
• Improve nutrition, especially protein.
• After surgery, support the incision with a pillow or hands when coughing, sneezing or laughing.
• Avoid heavy lifting and straining for at least 6 weeks or as advised.
• Treat constipation and coughs promptly.
• Report signs of wound infection or separation early.

Other meanings of evisceration

In eye surgery, evisceration means removing the contents of the eye while leaving the white outer shell, usually for a blind, painful eye. This is a planned operation, quite different from abdominal evisceration.

Frequently asked questions

What should you do for an evisceration?

Call 911 immediately. Do not push the organs back in. Cover them with a clean, moist dressing, then loosely with plastic wrap to keep them moist and warm. Keep the person lying down with knees slightly bent, keep them warm, and give nothing to eat or drink.

What is the difference between dehiscence and evisceration?

Dehiscence is the splitting open of a wound, which can be partial or complete. Evisceration is when a fully split abdominal wound allows organs such as the bowel to protrude. Dehiscence can lead to evisceration, which is always a surgical emergency.

When does evisceration happen after surgery?

It most commonly occurs 5 to 10 days after abdominal surgery, before the deep layers of the wound have gained strength. It is often triggered by coughing, vomiting or straining. A sudden gush of pink, watery fluid from the incision is a warning sign.

Why should you not push organs back in?

Pushing organs back can damage the bowel, tear blood vessels, introduce infection and make the injury worse. Surgeons need to inspect the organs for damage before returning them. Keeping them covered, moist and still until help arrives is safest.