Post-Surgery Care Challenges for Perforated Ulcer and Peritonitis Patients

Case #165471 Follow-up - Home Care Issues After Surgery for Perforated Stomach Causing Peritonitis

Dear Dr.
Chen,
Thank you for your response.
This morning, my family member began experiencing sharp pain in the swollen area, so we hurried back to the original hospital's emergency department.
The diagnosis confirmed that there is indeed a wound infection, and they will be kept under observation for one day.
I would like to provide you with some details regarding the clinical course.
It has been 16 days since the second surgery, with a one-month interval between the first and second surgeries.
During that month, the patient received treatment with drainage tubes, antibiotics, medications for peptic ulcers, anti-inflammatory pain relievers, and nutritional injections.
Due to the persistent formation of an abscess, the attending physician decided to perform a second debridement.
After the second surgery, there was one drainage tube in the left abdomen and two in the right abdomen, along with antibiotics, medications for peptic ulcers, and anti-inflammatory pain relievers (though the dosage was lower than after the first surgery), as well as nutritional injections, albumin, and fat treatment.

Currently, after the emergency visit, the abscess around the navel has been drained, and a significant amount of pus was expelled.
Blood tests showed a white blood cell count as high as 16,000, but blood pressure and heart rate are normal, with a slight fever, the highest temperature being 37.8°C.
After antibiotic injection, the temperature has decreased.
A CT scan revealed some residual abscess around the navel.
The emergency physician indicated that there is an abscess developing between the intestine and the wound, which may have created a channel for the pus to drain from the wound.
Could you please advise if the elevated white blood cell count indicates an abdominal infection, or is it merely a result of the wound infection causing the white blood cell count to rise? Thank you!
Sincerely,
Doctor Q&A Teams

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

Dr. Chen Jiaming reply Surgery

As you mentioned, the emergency physician expressed a significant amount of purulent fluid from the umbilical wound, and the patient's temperature is elevated.
This "wound infection with subcutaneous abscess formation" increases the likelihood of elevated white blood cell counts.
It is important to monitor the bacterial culture results; generally, due to the prolonged treatment period (over a month) and the continuous use of antibiotics during that time, there is a possibility of antibiotic resistance or strains that were previously suppressed by antibiotics.
However, most wound abscesses can gradually heal with incision and drainage followed by appropriate wound care, so there is no need for excessive concern.

Reply Date: 2021/02/14

More Info

Post-surgery care for patients who have undergone procedures for perforated ulcers and peritonitis can be quite complex, especially in the context of complications such as abscess formation and infection. Given the details you've provided, it seems your family member is experiencing a challenging recovery process, which is not uncommon in such cases.

Understanding the Situation
After surgery for a perforated ulcer, patients are at risk for several complications, including infections, abscesses, and delayed healing. The presence of a high white blood cell count (16,000 in your case) typically indicates an ongoing inflammatory response, which can be due to either a localized infection (such as at the surgical site) or a systemic infection (such as peritonitis). The fact that your family member has developed redness and swelling around the surgical site, along with pain, suggests that there may be an infection present.

Management of Infection and Abscesses
1. Antibiotic Therapy: It is crucial that your family member continues to receive appropriate antibiotic therapy. The choice of antibiotics should be guided by the results of cultures, if available, and the clinical judgment of the healthcare team.
2. Drainage of Abscesses: If there are abscesses, as indicated by the presence of pus, these may need to be drained. This can often be done percutaneously (through the skin) or surgically, depending on the size and location of the abscess.

3. Monitoring Vital Signs: Continuous monitoring of vital signs, including temperature, heart rate, and blood pressure, is essential. Any significant changes can indicate worsening infection or sepsis.

4. Nutritional Support: Given the patient's condition, nutritional support is vital. This may include intravenous nutrition (TPN) or enteral feeding, depending on the patient's ability to tolerate oral intake. The use of nutritional supplements can help improve recovery and support immune function.

5. Pain Management: Effective pain management is crucial for recovery. This may involve the use of analgesics and anti-inflammatory medications.

Post-Surgical Care Recommendations
- Wound Care: Proper wound care is essential to prevent further infection. This includes keeping the area clean and dry, changing dressings as advised, and monitoring for any signs of increased redness, swelling, or discharge.

- Follow-Up Imaging: Regular follow-up with imaging studies (like CT scans) may be necessary to monitor the status of any abscesses or fluid collections.

- Physical Activity: Encourage gentle movement as tolerated to promote circulation and prevent complications such as deep vein thrombosis, especially if the patient is bedridden.

- Communication with Healthcare Providers: It is important to maintain open lines of communication with the healthcare team. If there are concerns about the patient's condition, such as persistent fever or increasing pain, these should be reported immediately.

Conclusion
In summary, the elevated white blood cell count and the symptoms your family member is experiencing suggest an ongoing infection that needs to be addressed promptly. The management plan should focus on controlling the infection, ensuring adequate nutrition, and monitoring for any further complications. It is essential to work closely with the healthcare team to ensure that your family member receives the best possible care during this challenging recovery period.
If you have further questions or concerns, do not hesitate to reach out to the healthcare providers involved in your family member's care. They are best positioned to provide specific recommendations based on the patient's current condition and treatment plan.

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