[Infected abdominal wall and burst abdomen]. / Die infizierte Bauchdecke und der Platzbauch.

Deep wound infection of the abdominal wall and postoperative abdominal wound rupture are dangerous complications of laparotomy that require emergency operative intervention. The wound infection quota after laparotomy is between 5 and 10%. While subcutaneous infections heal without consequences after wound treatment, deep infections of incisional wounds are a problem. The cause is often an intra-abdominal infection. There are some standard operational measures: consistent debridement of the necrotic parts, careful re-exploration of the intra-abdominal site and early fascial closure with special sutures. All other procedures depend on the individual case. Abdominal wall rupture only occurs in 1% of the cases, but the mortality is high (15-45%). Besides local wound factors and the technical aspects, there a many general causes. Abdominal wall rupture also requires emergency operation. Repeated wound closure without further steps is possible in half of the cases. The mass technique should be used. Both deep wound infections and rupture are important complications in the development of incisional hernias.

[Anterior rectum resection and abdominoperineal rectum excision: guidelines for decision making]. / Anteriore Rektumresektion und abdominoperineale Rektumexstirpation: Richtlinien für die Entscheidungsfindung.

Carcinomae of the upper third of the rectum are, almost without exception, and without loss of continence, resectable. The diagnosis of an intact sphincter function is significant in the pre-operative phase, when deciding whether to carry out an anterior rectum resection or an abdominoperineal rectum exstirpation. Concerning tumours as from G3 in the middle and distal thirds, a safety margin of at least 5 cm distal must be kept, thus making an anterior resection impossible. Stage IV tumours whose growth has infiltrated neighbouring organs or the pelvic wall are also not suitable for resection. Should anatomical circumstances such as excessive adipositae, very large carcinomae, narrow pelvis and enlargement of the uterus or prostata prevent the safe dissection of the mesorectum a sphincter-retaining operation is also not indicated. Oncologic safety is of the highest priority when considering such cases.