Surgery
A 25-year-old man underwent an open appendectomy for a perforated appendix.
He was discharged on the 2nd post-operative day uneventfully. He returned on the 8th post-operative day complaining of pain and redness around the wound site. On examination, there is purulent discharge from the wound site. His abdomen is soft with tender over the wound site. Digital rectal examination was unremarkable. Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 38 °C Which of the following is the most appropriate management?
الشرح
Core Concept: This is a superficial surgical site infection after appendectomy. The key treatment is opening the wound and draining the pus. Antibiotics alone are insufficient because an abscess or infected collection requires source control.
Clinical Presentation:
- Wound pain, redness, warmth, and swelling
- Purulent discharge
- Fever or mild tachycardia
- Abdomen remains soft without generalized peritonitis
Diagnosis:
- First-line: Clinical wound examination.
- Gold standard/most accurate: Clinical diagnosis; CT abdomen is considered if a deep intra-abdominal abscess is suspected.
Management:
- Acute: Open the wound, drain the pus, send culture if needed, and perform regular dressing changes.
- Long-term/Definitive: Allow healing by secondary intention. Antibiotics are added if there is spreading cellulitis, systemic sepsis, or deep infection.