Surgery
A 58-year-old man had laparotomy with sigmoidectomy and colostomy for perforated diverticulitis, presented to…
A 58-year-old man had laparotomy with sigmoidectomy and colostomy for perforated diverticulitis, presented to the clinic complaining of intermittent attacks of fever for 1 week, Examination revealed normal chest and abdominal examination with healthy looking wound. Blood pressure 116/68 mmH, Heart rate 106 /min, Temperature 38.2 °C. Which of the following is the most appropriate next step?
Explanation
Core Concept: Postoperative intra-abdominal abscess following surgery for perforated diverticulitis (Hartmann's procedure).
Clinical Presentation:
- Persistent or spiking fevers, tachycardia, and leukocytosis days to weeks after abdominal surgery, even with a benign abdominal exam and a healthy-looking superficial wound.
Diagnosis:
- First-line/Gold standard: CT scan of the abdomen and pelvis with IV contrast to localize the deep fluid collection/abscess.
Management:
- Acute: IV antibiotics.
- Definitive: CT-guided percutaneous drainage is the gold standard for accessible abscesses. Surgical drainage is reserved for cases not amenable to percutaneous intervention or if the patient is clinically deteriorating.