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Case 83 - A 45-Year-Old Woman with a Foul-Smelling Pfannenstiel Incision on POD 7

Published online by Cambridge University Press:  19 November 2021

Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
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Summary

A 45-year-old female, gravida 2, para 2, presents to the office on postoperative day 7 after an uncomplicated total abdominal hysterectomy for abnormal uterine bleeding caused by a 20-week-sized fibroid uterus. She was discharged home on postoperative day 2 after a postoperative course complicated by some challenges managing her blood glucose. She called your office after noting foul-smelling yellow discharge from her Pfannenstiel incision site beginning last night. She also reports intermittent low-grade fevers for the past two to three days. She is still taking ibuprofen and acetaminophen (Tylenol) for pain relief. She took her last ibuprofen dose this morning with breakfast. She rates her pain as 7–8/10. She has pain at and around the incision site and can express discharge from the wound when pressing on surrounding areas. She denies urinary or gastrointestinal symptoms. Her past medical history is significant for well-controlled hypertension and poorly controlled and long-standing diabetes. She takes hydrochlorothiazide, metformin, and long-acting insulin. Her surgical history is significant for two cesarean deliveries. She has no known drug allergies.

Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
, pp. 254 - 256
Publisher: Cambridge University Press
Print publication year: 2021

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References

National Healthcare Safety Network, Centers for Disease Control and Prevention. Surgical site infection (SSI) event. Published January 2017. Available at: http://www.cdc.gov.proxy.library.emory.edu/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. (Accessed September 14, 2020.)Google Scholar
Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152(8): 784–91. doi:10.1001/jamasurg.2017.0904. Erratum in: JAMA Surg 2017; 152(8): 803.CrossRefGoogle Scholar
Prevention of infection after gynecologic procedures: ACOG Practice Bulletin, Number 195. Obstet Gynecol 2018; 131: e172–89.Google Scholar
Steiner, HL, Strand, EA. Surgical-site infection in gynecologic surgery: pathophysiology and prevention. Am J Obstet Gynecol 2017; 217: 121–8.CrossRefGoogle ScholarPubMed
Mueck, KM, Kao, LS. Patients at high-risk for surgical site infection. Surg Infect (Larchmt) 2017; 18(4): 440–6. doi: 10.1089/sur.2017.058.CrossRefGoogle ScholarPubMed
Clarke-Pearson, DL, Geller, EJ. Complications of hysterectomy. Obstet Gynecol 2013; 121(3): 654–73. doi: 10.1097/AOG.0b013e3182841594.CrossRefGoogle ScholarPubMed
Lazenby, GB, Soper, DE. Prevention, diagnosis, and treatment of gynecologic surgical site infections. Obstet Gynecol Clin North Am 2010; 37: 379–86. https://doi.org/10.1016/j.ogc.2010.05.001.Google Scholar
Yu, L, Kronen, RJ, Simon, LE, et al. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol 2018; 218: 200–10.e1. https://doi.org/10.1016/j.ajog.2017.09.017.CrossRefGoogle ScholarPubMed

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