Post-Surgery Care for Perforated Stomach and Peritonitis: Key Concerns

Post-operative home care issues following surgery for perforated gastric ulcer leading to peritonitis?

Hello Doctor: A family member (57-year-old female) underwent emergency surgery due to a gastric perforation that led to peritonitis, resulting in a total hospital stay of 45 days and two abdominal surgeries.
The first surgery was an emergency procedure; due to severe abdominal infection, a traditional open surgery was performed instead of minimally invasive laparoscopic surgery.
Post-operatively, a drainage tube was used to allow the abscess to drain.
However, as the abscess could not be completely drained, a second debridement surgery was performed, extending the incision about 3 cm below the navel.
Following this, the abscess gradually decreased to less than 10 ml with continued drainage treatment, allowing the attending physician to assess that discharge was appropriate.
Currently, it has been four days since discharge.

On the first and second days after discharge, while changing the dressing, everything appeared normal with no redness, swelling, or pain.
However, on the third day, there was some redness and swelling around the navel, but the family member did not experience any bloating, pain, or other unusual sensations.
On the fourth day, there was a brief episode of severe pain in the lower abdomen, described as cramping, not related to the surgical site, and there was no pain in the upper abdomen.
During the evening dressing change, the redness and swelling around the navel appeared slightly worse than the previous day.
When asked if there was any pain or bloating, the family member reported no unusual sensations.
After covering the wound, I lightly pressed around the reddened area near the navel, and the family member indicated slight pain upon pressure, but it was not severe.
They reported no pain or bloating when not pressed.
After considering the situation, I advised the family member to take the anti-inflammatory and pain medication prescribed by the attending physician and to observe the situation for the next day.
However, I am concerned about the possibility of a delay in treatment and would like to ask what might be causing these symptoms.
Should we return to the emergency department immediately? Thank you, Doctor, for your guidance.
I appreciate your help.
Best regards.

Ms. Wu, 20~29 year old female. Ask Date: 2021/02/14

Dr. Chen Jiaming reply Surgery

Due to the lack of specific details regarding the clinical course (such as the interval between the second surgery and the discharge date), along with the observed changes during the medication change after discharge (suspected wound infection), it is advisable for you to return to the original treating hospital for further evaluation and treatment as soon as possible.

Reply Date: 2021/02/14

More Info

Post-surgery care for a perforated stomach and peritonitis is crucial for ensuring a smooth recovery and preventing complications. Given your family member's recent history of surgery, including two operations and the use of drainage tubes, it is understandable to be concerned about any changes in their condition, especially regarding redness and swelling around the surgical site.

Firstly, it is important to recognize that some degree of redness and swelling can be normal after surgery, particularly in the early days of recovery. This is often due to the body's natural inflammatory response to surgery, which is part of the healing process. However, the fact that the redness around the navel area has increased and that there was a report of sharp pain in the lower abdomen raises some concerns that should be addressed.

1. Signs of Infection: The increased redness and swelling could indicate a potential infection, especially since your family member had a history of abdominal infection and surgery. While the absence of pain is a positive sign, it is essential to monitor for other symptoms such as fever, increased drainage from the wound, or any unusual discharge. If any of these symptoms develop, it would warrant immediate medical attention.

2. Pain Management: The sharp pain described in the lower abdomen could be related to several factors, including gas buildup, bowel movement issues, or even complications related to the surgery. It is good that you have provided pain relief as prescribed by the physician. However, if the pain persists or worsens, it is crucial to consult with the healthcare provider.

3. Monitoring the Surgical Site: Continue to monitor the surgical site closely. If the redness continues to spread, or if there are any signs of increased swelling, warmth, or discharge, it is advisable to return to the hospital for further evaluation. The healthcare team may need to assess whether there is an abscess or other complications that require intervention.

4. Follow-Up Care: Ensure that your family member attends all scheduled follow-up appointments with their surgeon. These visits are essential for monitoring recovery and addressing any concerns that may arise. If there are any doubts or if the condition seems to worsen, do not hesitate to seek medical advice sooner rather than later.

5. Diet and Activity: Post-surgery, it is essential to follow dietary recommendations provided by the healthcare team. A bland diet may be recommended initially, gradually reintroducing other foods as tolerated. Encourage your family member to stay hydrated and to avoid strenuous activities until cleared by their doctor.

6. Emotional Support: Recovery from major surgery can be mentally and emotionally taxing. Providing emotional support and encouragement can help your family member cope with the recovery process.

In summary, while some redness and discomfort can be expected after surgery, the changes you have observed should not be ignored. It is always better to err on the side of caution when it comes to post-surgical care. If there are any signs of infection or if the pain becomes severe, returning to the hospital for evaluation is the best course of action. Your proactive approach in monitoring their condition and seeking guidance is commendable and essential for their recovery.

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