Surgery
Pt post op perforated diverticulitis, on the 4th day post op he developed fever 38.9 ( no details or symptoms…
Pt post op perforated diverticulitis, on the 4th day post op he developed fever 38.9 ( no details or symptoms at all just like this ) Which of the following is the most right to be done?
الشرح
Core Concept: Postoperative fever evaluation. The etiology of post-op fever is classically taught using the '5 Ws': Wind (atelectasis/pneumonia, POD 1-2), Water (UTI, POD 3-5), Walking (DVT/PE, POD 4-6), Wound (Surgical Site Infection, POD 5-7), and Wonder drugs (Drug fever, >7 days). By POD 4, wound infections and intra-abdominal abscesses become prominent differentials.
Clinical Presentation:
- New-onset fever, tachycardia, and potentially localized pain or erythema.
Diagnosis:
- First-line: A thorough bedside physical examination, specifically inspecting and palpating the surgical wound and abdomen.
- Gold Standard: Targeted imaging (e.g., CT abdomen/pelvis) or cultures based on physical exam findings.
Management:
- Acute: Perform a comprehensive physical exam to check the wound for Surgical Site Infection (SSI) and the abdomen for signs of an anastomotic leak or abscess.
- Definitive: Open and drain the wound if an SSI is present, or perform percutaneous/surgical drainage for deep space infections, accompanied by targeted antibiotics.