Postop Infection

Question 1

Regarding SSI management
(Sequence of 3 steps)

Answer 1

1. Wound exploration
2. CT
3. Percutaneous drainage

Question 2

Post-op intra abdominal collection management:

Answer 2

🔸Small size: ABx
🔸> 4x4: percutaneous drainage
🔸Multiple collections: laparoscopy
🔸Unstable: laparotomy

Question 3

What does “Open drainage” means ?

Answer 3

Percutaneous drainage which is done after CT

Question 4

25 yo patient developed wound site redness & tenderness with purulent discharge post surgery day 8. Initial tx:

A. IV Antibiotics
B. CT abdomen
C. Open drainage
D. Exp lap

Answer 4

CT abdomen
SSI: wound exp » CT » percutaneous drainage

Question 5

Patient with perforated appendicitis after surgery had pus from the wound, pain localized to surgical site, no fever no guarding. Best initial tx:

A. Antibiotics
B. Open drainage
C. Imaging guided drainage
D. Wound exploration

Answer 5

Wound exploration
SSI: wound exp » CT » percutaneous drainage

Question 6

Post appendectomy female came with RLQ mild tenderness. PE normal, CT: 2x2 retrocecal collection. Best management:

A. Exp lap
B. Percutaneous drainage
C. Laparoscopy
D. Conservative with ABX

Answer 6

Conservative with ABX
Intra-abd collection ~SMALL~

Question 7

Patient post appendectomy present for f/u on exam there is seroma which drains freely from the wound. No erythema or pain, no fever. Most appropriate management:

A. Observation
B. Open wound exploration
C. Regular wound dressing
D. US-guided drainage

Answer 7

Regular wound dressing
“Seroma”

Question 8

Post lap hernia repair day 7, patient present with pus from wound site. You found 2x3 collection of pus and its oozing from the wound, he is afebrile. Management?

A. Abx
B. Drainage
C. Drainage & remove mesh
D. Open the wound and leave it open

Answer 8

Open the wound and leave it open

Question 9

A Crohn’s patient present with abd pain, fever, vomiting & diarrhea with tenderness. CT: 12x15 collection and ileu-jejunal fistula.

A. Laparoscopic drainage
B. Percutaneous drainage
C. Open drainage
D. Open drainage with fistula resection

Answer 9

Percutaneous drainage
Intra-abd collection ~LARGE >4x4~

Question 10

Post lap chole 2 weeks later c/o vague abd pain. CT: large collection in subhepatic area.
Most appropriate next management:

A. Operative drainage
B. CT-guided drainage
C. Laparoscopic drainage
D. ERCP with biliary stent placement

Answer 10

CT-guided drainage
Inta-abd collection ~LARGE~ “Biloma”