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Phenotype submission - Fascial dehiscence and evisceration

Cohort Definition Name: Fascial dehiscence and evisceration

Contributor name: Andreas Weinberger Rosen

Contributor OrcId: 0000-0001-9990-8155

Logic Description: First fascial dehiscence or evisceration

Recommended study application: exposure, outcome, indication. Created intended to be used after abdominal surgery.

Assertion statement: This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.

Submitted cohort definition:
fascial dehiscence and evisceration.txt (2.7 KB)

Target Clinical Description

Fascial dehiscence is a severe postoperative complication involving the separation of the layers of the fascia that were surgically closed after abdominal surgery. Evisceration is an even more critical situation where the internal organs protrude through the opened fascial layers. Both of these complications pose significant risks, such as infection, sepsis, and even death, if not promptly managed.

Presentation of Fascial Dehiscence and Evisceration

Common presentations for fascial dehiscence and evisceration include:

  • Sudden onset of abdominal pain
  • Visible or palpable "pop" at the surgical site
  • Opening of the surgical wound with potential visible internal organs
  • Signs of infection like fever and increased leukocyte count
  • Hemodynamic instability

Assessment for Fascial Dehiscence and Evisceration

  • Immediate physical examination, focusing on the surgical site
  • Abdominal imaging like CT scan for assessing the extent 

of dehiscence and associated complications

  • Blood tests including complete blood count and inflammatory markers
  • Urgent surgical consultation for potential reoperation

Differential Diagnosis of Fascial Dehiscence and Evisceration

  • Surgical site infection without dehiscence
  • Incisional hernia
  • Hematoma or seroma at the surgical site
  • Simple wound breakdown
  • Non-specific postoperative pain

Treatment Plan for Fascial Dehiscence and Evisceration

Immediate surgical intervention is often required to close the fascial layers and prevent further complications. Broad-spectrum antibiotics are initiated to reduce the risk of infection. Fluid resuscitation may be necessary to manage hemodynamic instability. In case of sepsis, sepsis protocols including aggressive antibiotic therapy should be initiated.

Prognosis for Fascial Dehiscence and Evisceration

The prognosis is variable and largely dependent on the speed of diagnosis and initiation of treatment. Immediate surgical intervention can significantly improve outcomes. Delayed treatment, however, can lead to a host of complications like sepsis, organ failure, and even death. Prognosis also depends on the patient’s overall health and the presence of comorbid conditions that may complicate recovery.

Assignment for Peer Review:
Peer review of the phenotype would be more than welcome

Imported to the OHDSI Phenotype Library. It may be expected to be found with id = 803 in the next release. Thank you