Changes

The defect is approached by a ventral midline coeliotomy (which may be extended cranially beside the xiphisternum or into a median sternotomy) and the abdominal organs are retracted.  Fibrinous adhesions can be easily separated but strangulated organs (such as torsed liver lobes or loops of small intestine) should be resected.  If the rupture has been present for a long period, its fibrous edges may be debrided before suturing using polydioxanone.  If there is a large defect that cannot be closed without tension, the following approaches may be used:

The defect is approached by a ventral midline coeliotomy (which may be extended cranially beside the xiphisternum or into a median sternotomy) and the abdominal organs are retracted.  Fibrinous adhesions can be easily separated but strangulated organs (such as torsed liver lobes or loops of small intestine) should be resected.  If the rupture has been present for a long period, its fibrous edges may be debrided before suturing using polydioxanone.  If there is a large defect that cannot be closed without tension, the following approaches may be used:

*Transversus abdominis flap

*Use of the muscle transversus abdominis as a flap to fill the defect

*Use of porcine intestinal submucosa or synthetic mesh

*Use of porcine intestinal submucosa or synthetic mesh to fill the defect

*Graft of omentum over sutures placed in the diaphragm  

*Graft of omentum over sutures placed in the diaphragm

====Post-operative Care====

====Post-operative Care====