Journal of Obstetrics and Gynaecology (2000) Vol. 20, No.

6, 612 613

OBSTETRIC SHORT COMMUNICATION

Burst abdomen following caesarean section: a

preventable surgical complication
F. O. DARE, A. U. BAKO and O.C. EZECHI
Department of Obstetrics and Gynaecology, College of Health Sciences, Obafemi Awolowo
University, Nigeria

Caesarean section is becoming more acceptable to

patients in Nigeria, probably because of the better
education of our pregnant women and the increasing
safety of the operation (Megafu, 1988) . Burst
abdomen (synonymou s with dehiscence) with an
incidence of 07 21% is a recognised life
threatening complication of abdominal surgery
including caesarean section (Wahl et al., 1992). This
retrospective review of patients with post-caesarea n
burst abdomen between January 1985 and December
1994 at Ife State Hospital (ISH) was undertaken in
order to study their characteristics and offer preventive measures in an environment where maternal
mortality and morbidity is relatively high and
caesarean section is still regarded with Grave concern
by some pregnant women.
Data relating to maternal age, parity, body mass
index, booking status, gestational age at delivery, past
surgical history, labour history and packed cell volume
at surgery were collated and analysed. Type and indication for caesarean section, use of antibiotics, time of
diagnosis of burst abdomen, wound swab bacteriology
and outcome of treatment were also recorded and
analysed.
During the period under review, 1719 caesarean
sections (including caesarean hysterectomies) were
performed. Fourteen patients suffered a burst
abdomen, giving a rate of 08%. Socio-demographi c
and obstetric characteristics of the patients are shown
in Table I. The indications for surgery were prolonged
obstructed labour (643%), antepartum haemorrhage (286%) and fetal distress (71%). The rectus
sheath was repaired with chromicized catgut in all
cases. Three patients (214%) had one previous
caesarean section with midline skin incision;
antibiotics were started after surgery in the majority
(857%) of patients. Only 143% of the patients had
pre-operative antibiotics. A majority of the patients
(714%) developed the burst abdomen on the 7th
postoperative day (range 5 8 days). Similarly, most
of the patients (786%) had bacteriological evidence
of wound sepsis, with Staphylococcu s aureus and
Pseudomonas species being the most common organisms. Anaerobic culture was not performed during
the study period because of lack of facilities. Thirteen
patients (929%) had rectus sheath repair with interrupted nylon 1 sutures with tension sutures. The mean

Table I. Socio demographic and obstetric characteristics

Age (years)

20 24
25 29
30 34
35 39
Parity
1
2 4
>4
Body mass index (weight in kg/height (m2)
<20
20 25
>25
Booking status
Unbooked
Booked
EGA at delivery (weeks)
28 37
38 42
Associated medical problem*
Cough
Anaemia
Acute renal failure

6 429
1 71
2 143
5 357
5 357
3 214
6 429
2 143
4 286
8 571
10 714
4 286
3 214
11 786
1 71
11 786
1 71

* Some patients had more than one medical condition.

hospital stay of the patients was 316 days (range

21 56 days). One patient in a very poor clinical state
died before repair could be undertaken while another
died after repair from overwhelming septicaemia,
giving a case mortality rate of 143%.
The burst abdomen rate of 08% after caesarean
section is similar to the ndings of other authors
(Wahl et al., 1992). Although not signi cant in this
series, elderly patients are known to be more
susceptible to wound-healing problems (Jones and
Millman, 1990). Body mass index greater than 25 is
also associated with a higher risk of burst abdomen;
571% of the patients in this review had a body mass
index greater than 25. Patients having emergency
surgery have been shown to be at a higher risk of
developing burst abdomen possibly because of the
increased chance of errors in sterile procedure (Wahl
et al., 1992). As was found in this study, a subumbilical midline incision was performed in 929% of
the patients, which is an inherently weak scar more

Correspondence to: F. O. Dare, Department of Obstetrics and Gynaecology, College of Health Sciences, Obafemi Awolowo
University, Ile-Ife, Osun State, Nigeria.
ISSN 0144 3615 print/ISSN 1364 6893 online/00/060612 02 Institute of Obstetrics and Gynaecology Trust, 2000
DOI: 10.1080/01443610020001468

Burst abdomen following caesarean section

prone to burst abdomen (Badoe et al., 1994; Mann,

1995). The relative avascularity of the linear alba
and greater impact of the stress of postoperative
abdominal distension on the scar could be responsible
for the weak nature of midline incisions. Wound
dehiscence was higher in this series because of the
frequent use of midline scar, the closure of the rectus
sheaths with chromicised catgut and also the high
rate of wound infection (786%). As caesarean section
becomes acceptable and more common in developing
world, a high premium should be placed on the use
of antibiotics, the use of non-adsorbabl e sutures to
the sheaths of midline incisions or at least the use of
suture materials such as polydioxanone (PDS),
which takes a long time to be absorbed, and the use
of vicryl for the sheath in pfannestiel incisions so as
to reduce or prevent the development of burst
abdomen.

613

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