Urological Emergencies in Clinical Practice стр.110

To help avoid anaphylaxis you should always ask patients before giving them any medication or intravenous contrast if they have any allergies at all including drug allergies and to document that clearly in the case notes.

SCROTAL SWELLING AFTER SCROTAL SURGERY

Occasionally a large scrotal haematoma can develop after scrotal surgery such as vasectomy, hydrocele repair, or orchidectomy. This occurs in approximately 2% of cases (Kendrick et al. 1987). If the haematoma is large, surgical drainage is best carried out. It can be difficult to identify the bleeding vessel. Leave a small drain to prevent reaccumulation of the haematoma.

7. POSTOPERATIVE EMERGENCIES AFTER UROLOGICAL SURGERY

WOUND DEHISCENCE LEADING TO BURST ABDOMEN Definition

This is the disruption of the apposed surfaces of a wound resulting in the breakdown of skin and deeper musculoaponeurotic layers exposing the viscera (Dickenson and Leaper 1999). It typically occurs in the first week postoperatively (Fig. 7.1).

Factors predisposing to wound dehiscence are patient-related and surgeon-related. Patient-related factors include obesity, diabetes, immunosuppression, malnutrition, malignancy, sepsis, and emergency operation. These factors favour the occurrence of wound infection and dehiscence. Other factors include coughing and straining postoperatively, which increase intraabdominal pressure and put extra tension on the sutures.

Surgeon-related factors: tying sutures too tightly can result in the suture cutting through fascial layers. There is a higher rate of wound dehiscence where suture length is less than 4x the length of the wound (Jenkins's rule).

Diagnosis

Daily wound examination may show signs of wound infection, which predisposes to wound dehiscence. Signs of impending

Urological Emergencies in Clinical Practice

FIGURE 7.1. A wound dehiscence following cystectomy. The patient has an ileal conduit adjacent to the extruded abdominal contents. (See this figure in full color in the insert.)

146 H. HASHIM AND J.REYNARD

wound dehiscence are skin breakdown and discharge of serosan-guinous 'pink' fluid from the wound. You may be called to the ward because the patient's abdomen has suddenly burst, exposing the small and large bowel.


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