The burst abdomen (BA) is a severe complication after abdominal surgery. The incidence is about 1–14%, depending on the initial surgery. Numerous risk factors have been identified, with the highest risk for deep wound infection. Complete BA (evisceration) is a clear diagnosis, whereas clinical examination, ultrasound, and CT play a key role in the diagnosis of incomplete BA (fascial dehiscence with closed skin). The operative management comprises re-laparotomy and thorough exploration. If primary fascial closure is possible, it should be obtained with a slowly absorbable monofilament running suture warranting a suture-to-wound-length-ratio of ≥5:1 and the implantation of a prophylactic onlay mesh. If fascial closure is impossible initially, open abdomen therapy is indicated.