Tribune (Excerpts): A viral video shot inside
Kashmir valley’s main tertiary care hospital showed a patient with his abdomen
slit open and attendants pleading for help and alleging doctors of negligence.
An inquiry was ordered immediately.
The complete picture of the video, however, reveals
it was the ignorance of the attendants and not the negligence of the doctors.
The patient, suffered from wound dehiscence and
also peritoneal carcinomatosis, a rare type of cancer that can develop when
gastrointestinal cancer spread and cause tumors to grow in the thin layer of
tissue that lines the abdomen and covers most of the abdominal organs.
In such cases, once the wound has opened up
(dehiscence), a time gap is given before secondary suturing.
Wound dehiscence
Wound dehiscence or opening of the wound along the
line of incision, occasionally occurs in surgical wounds postoperatively
despite a carefully performed layered closure. It is common in the first week
after the surgery.
The risk of wound dehiscence is increased by
factors such as wounds in high-tension areas (superior trunk, proximal upper
extremities), older age, malnutrition, anemia, diabetes, intra-abdominal
infection, poor patient compliance to postoperative advice, drugs such as
systemic corticosteroids.
Surgical wounds that heal by primary intention are
healed 5-10% after one week and after 1 to 2 months, they are 50% healed. About
80% of normal skin strength is regained several months after the surgery.
Hence, it is important to avoid stress during the first few weeks after the
surgery.
Even mild activity may adversely affect the
strength of the wound sutures. Patients should be advised to limit lifting no
more than 15 pounds for two weeks after surgery and only gradually increasing
activity as tolerated. Walking can be continued within a day or two of surgery.
Elevation of leg to decrease edema in lower extremity wounds may put stress on
the healing wound.
What is carcinomatosis?
Carcinomatosis is a condition in which cancer is
spread widely throughout the body, or, in some cases, to a relatively large
region of the body. It is also called carcinosis.
Peritoneal carcinomatosis
Several gastrointestinal and gynecological
malignancies have the potential to disseminate and grow in the peritoneal
cavity called peritoneal carcinomatosis. It is often associated with disease
progression and poor prognosis.
Peritoneal carcinomatosis has been shown to
significantly decrease overall survival in patients with liver and/or
extraperitoneal metastases from gastrointestinal cancer. Moreover, overall
survival in these patients is usually only slightly influenced by systemic
chemotherapy. Hence, peritoneal carcinomatosis is traditionally regarded by the
surgeon as a terminal condition.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
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