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Question 1126
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Title Management of a 57-year-old man with post-operative fever and evidence of wound
infection

Last 2018-05-14 16:41:57

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An otherwise t 57-year-old woman spikes a fever of 39°C ve days after an

appendicectomy for acute appendicitis. On examination, there is a tender,
erythematous and uctuant swelling at the medial end of the wound. Which one of the
following options would be the most appropriate next step in management?

A Administer high dose, broad spectrum antibiotics, intravenously.

B Return the patient to the OR for resuturing the wound.

C Start the patient on oral antibiotics.

D Make an incision over the swelling to allow free draining.

E Remove the underlying suture material to prevent sinus formation.

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Option D is correct

The tender, erythematous, uctuant swelling at the surgical site indicates abscess formation as a
post-operative complication of the surgical wound. Once abscess is formed, incision and drainage is
the most appropriate management to considered rst. Intravenous antibiotics are indicated as
an adjunctive therapy.

Wound infection and abscesses are common post-operative complications of surgical procedures.
Often, wound infections are expected on the seventh day post-op or thereabouts. Abscess formation
usually takes longer; nonetheless these timings are inaccurate, and surgical complications can
potentially occur at any time during the post-operative period. Simple wound infections present with
surrounding cellulitis (erythema and local tenderness). Abscesses, on the other hand, are more
indurated and uctuating and characteristically contain puss; they tend to cause higher fevers.

(Option A) Intravenous antibiotics are used after incision is made to let free drainage of the abscess.
Intravenous antibiotics are necessary, particularly in this patient with systemic infection and high
fever, but are not su cient if used alone. Wound infections with cellulitis but no uctuance can be
treated with a course of antibiotics without drainage. However, when clinical ndings suggest an
abscess, incision and drainage is the mainstay of therapy.

(Option B) Opening the wound, irrigation and resuturing is not an e ective management for
abscesses. The sutures are removed, wound debridment and irrigation is performed, but the wound
is left open and packed.

(Option C) Oral antibiotics are de nitely insu cient for management of this wound infection. Such
infections often require intravenous antibiotics after incision and drainage has been carried out.

(Option E) Removal of the underlying suture material to prevent sinus formation is important but
does not treat the patient’s current condition.

Reference(s)
http://cursoenarm.net/UPTODATE/contents/mobiprevie (http://cursoenarm.net/
UPTODATE/contents/mobipreview.htm?9/36/9793?source=HISTORY)
http://www.racgp.org.au/afp/2013/december/post-ope (http://www.racgp.org.au/
afp/2013/december/post-operative-wound-management/)

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