jameskim
08-20-2009, 01:12 PM
38-year-old woman, gravida 4, para 4, comes to the physician 8 days after a cesarean delivery complaining of redness and pain at the leftmost aspect of her incision. Her cesarean delivery was performed secondary to a non-reassuring fetal heart rate tracing. She was feeling well after the operation until 4 days ago, when she developed pain and redness around her incision. Her temperature is 37 C (98.6 F), blood pressure is 118/78 mm Hg, pulse is 88/min, and respirations are 12/min. There is marked erythema and induration around the incision. At the left margin of the incision there is a fluctuant mass. Which of the following is most appropriate next step in management?
Expectant management
Oral antibiotics only
IV antibiotics only
Incision and drainage
Laparotomy
ans is Incision and drainage. This patient most likely has a wound abscess. When antibiotic prophylaxis is used, wound infections occur at a rate of approximately 1% after cesarean deliveries. However, this patient appears to have more than a cellulitis. The fluctuant mass at the leftmost aspect of the incision is highly likely to be an abscess. The proper treatment for a wound abscess is with incision and drainage.This patient is unlikely to improve with expectant management (choice A). An abscess almost always requires incision and drainage for cure. Expectant management may lead to worsening of the infection, with the possibility of spread to adjacent structures (e.g., fascia) or to bacteremia and sepsis.Oral antibiotics only (choice B) or IV antibiotics only (choice C) may not resolve the abscess. Antibiotics often do not penetrate the abscess cavity.
Expectant management
Oral antibiotics only
IV antibiotics only
Incision and drainage
Laparotomy
ans is Incision and drainage. This patient most likely has a wound abscess. When antibiotic prophylaxis is used, wound infections occur at a rate of approximately 1% after cesarean deliveries. However, this patient appears to have more than a cellulitis. The fluctuant mass at the leftmost aspect of the incision is highly likely to be an abscess. The proper treatment for a wound abscess is with incision and drainage.This patient is unlikely to improve with expectant management (choice A). An abscess almost always requires incision and drainage for cure. Expectant management may lead to worsening of the infection, with the possibility of spread to adjacent structures (e.g., fascia) or to bacteremia and sepsis.Oral antibiotics only (choice B) or IV antibiotics only (choice C) may not resolve the abscess. Antibiotics often do not penetrate the abscess cavity.