Post-Surgery Complications After Gastric Perforation and Peritonitis Treatment - Surgery

Post-treatment issues following gastric perforation leading to peritonitis?

---

Dear Dr.
Chen,
I hope this message finds you well.
I would like to provide a detailed account of my family member's clinical course due to a gastric perforation leading to peritonitis, in hopes of receiving a comprehensive response.
My family member, a 57-year-old female, underwent emergency surgery for a gastric perforation and peritonitis, resulting in a total hospital stay of 45 days and two abdominal surgeries.
The interval between the first and second surgeries was one month.
During this month, she received treatment with drainage tubes, antibiotics, medications for gastric ulcers, anti-inflammatory pain relief, and nutritional support.
Due to persistent abscess formation, the attending physician decided to perform a second debridement surgery.
After the second surgery, she had one drainage tube in the left abdomen and two in the right abdomen, along with antibiotics, gastric ulcer medications, anti-inflammatory pain relief (at a lower dosage than after the first surgery), nutritional support, albumin, and fat therapy.
The first surgery was an emergency procedure, as the abdominal infection was too severe for laparoscopic surgery, necessitating traditional open surgery.
Post-operatively, drainage tubes were 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, allowing the attending physician to assess her for discharge.
Three days post-discharge, redness and swelling appeared around the navel, but she did not experience any bloating, pain, or other unusual sensations.
On the fourth day, she experienced a brief, severe pain in the lower abdomen, described as cramping rather than incision pain, with no discomfort in the upper abdomen.
However, during the evening dressing change, the redness and swelling around the navel appeared more pronounced than the previous day.
When asked about pain or bloating, she reported no unusual sensations.
Upon lightly pressing the swollen area around the navel, she felt slight pain, but it was not severe, and she did not feel any discomfort without pressure.
On the morning of the fourth day post-discharge, the redness and swelling began to cramp, prompting a return to the original hospital's emergency department.
A CT scan revealed some residual abscess around the navel due to wound infection, with subcutaneous abscess formation extending to the intestines, creating a channel for the abscess to drain from the wound, necessitating readmission for treatment.
Currently, she is being treated with antibiotics, gastric ulcer medications, anti-inflammatory pain relief (at a lower dosage than after the second surgery), nutritional support, and fat therapy.
Today marks the 27th day of her second hospitalization, which is one month and 12 days since the second surgery.
She no longer experiences cramping in the abdomen, with heart rate maintained at 90-100 bpm, oxygen saturation at 94-96%, and blood pressure ranging from 110-160 mmHg.
Her condition has improved significantly since the second hospitalization, with the abdominal wound drying considerably, minimal abscess presence, and no longer packing gauze in the wound to promote healing.
Currently, intravenous medications are administered through a central line in her neck.
However, around the third week of her second hospitalization, the injection site began to show redness and swelling, accompanied by a slight fever.
Blood cultures indicated the presence of bacteria in her bloodstream, leading to the replacement of the central line and a switch to a different antibiotic.
Unfortunately, she began experiencing dry heaving (vomiting has persisted for over a week).
The attending physician assessed the situation and decided to discontinue the antibiotic treatment.
It has now been four days since stopping the antibiotics, but her vomiting has worsened, occurring up to ten times a day.
During vomiting episodes, her blood pressure rises, peaking around 150 but not exceeding 160 mmHg.
Severe dry heaving has resulted in the expulsion of some bile (greenish).
X-rays, blood cultures, and urine tests have all returned normal results, except for low hemoglobin levels.
This morning, she received two units of blood, and since last night, she has been administered sleep aids to prevent excessive vomiting.
Today, her vomiting has improved significantly.
The primary inquiry is regarding the medical team's assessment that the vomiting could be a side effect of the antibiotics.
However, it has been four days since the antibiotics were stopped, and she continues to vomit.
The attending physician indicated that all test values are normal, and her weight remains stable at 60-62 kg, with no significant fluctuations.
Therefore, we are unsure of the cause of her severe vomiting.
I would like to ask if you believe there may be other underlying issues causing her vomiting, or if it is merely a simple drug side effect.
Should we consider further examinations for her? Is it necessary to transfer her to another hospital for treatment? If so, which hospital and specialty would be appropriate for effective treatment?
Thank you, Doctor! I sincerely appreciate your guidance.
Best regards,
Doctor Q&A Teams

---

Ms. Lu, 20~29 year old female. Ask Date: 2021/03/12