Post-op - WOUND ISSUES

Question 1

On POD5 after open laparotomy, the patient calls, explaining that her wound seems intact but that there are large amounts of pink “salmon-colored” fluid soaking her dressings.

1. Likely diagnosis
2. Dx
3. Tx

Answer 1

1. Wound dehiscence
   - typically around POD5 after open laparotomy
   - wound appears intact
   - large amts of salmon-colored fluid soak dressings (peritoneal fluid)
2. Dx: Clinical
3. Tx:
   - tape wound securely
   - bind abdomen
   - mobilization/coughing with great care
   - prompt reoperation to prevent evisceration now or ventral hernia later

Question 2

A post-laparotomy patient presents around POD7 with bowels coming out of his wound. He had noted salmon-colored fluid drenching his dressings for the past few days, then suddenly when he got out of bed this afternoon, the skin around his wound opened up.

1. Likely diagnosis
2. Dx
3. Tx

Answer 2

1. Evisceration
   - catastrophic complication of wound dehiscence, where skin itself opens up and abdominal contents rush out
   - typically happens when patient (who has dehisced) coughs, strains, or gets out of bed
2. Dx: Clinical
3. Tx:
   - keep patient in bed and cover bowel w/large sterile dressings soaked in warm saline
   - emergency abdominal closure required

Question 3

A post-op patient presents due to yellow-green liquid leaking from his drain site.

1. Likely diagnosis
2. Complications
3. Riskiest sites for complications (rank high to low risk)
4. Tx

Answer 3

1. GI fistula
   - bowel contents leak through wound/drain site
   - in this case, draining freely without pooling anywhere inside (afebrile, no peritoneal signs)
2. Complications:
   - ->fluid & electrolyte loss
   - ->nutritional depletion
   - ->erosion/digestion of belly wall
3. Riskiest sites for complications (high to low risk)
   - -high-volume (several L/day) fistulas high in GI tract (stomach to upper jejunum)
   - -low-volume (

Question 4

A post-op patient presents with fever and elevated heart rate. His surgical wound is leaking, but a firm lump is felt underneath it as well.

1. Likely diagnoisis
2. Complications
3. Tx

Answer 4

1. GI fistula, non-freely draining
   - bowel contents leak through wound/drain site
   - in this case, the wound is not draining freely & completely to the outside; rather, it has formed a “cesspool” from which it leaks out
2. Complications: –> Sepsis
3. Tx: Requires complete drainage
   (and other GI fistula treatment)