Persistent Wound Issues After Appendicitis Surgery: Seeking Answers

Appendicitis complicated by peritoneal abscess; it has been 60 days post-surgery, and the wound has not yet healed, which is concerning?

Hello Dr.
Hsieh,
I was admitted to Keelung Chang Gung Hospital on December 22 due to pain in my lower right abdomen, where I was diagnosed with appendicitis, which had ruptured and caused peritonitis.
I underwent an appendectomy and abdominal drainage.
I was discharged on December 31.
However, on the evening of January 1, I experienced a large amount of bloody pus.
I returned to Chiayi Chang Gung Hospital on January 2 for outpatient care, where I had another drainage procedure and was prescribed antibiotics for three days.
During this time, the appendectomy wound healed.
By January 27, the drainage site had not healed for almost a month and continued to produce pus (yellow fluid), with granulation tissue protruding from the drainage hole.
I returned to Keelung Chang Gung outpatient clinic, where it was determined that there was likely a suture material rejection infection.
Granulation tissue was excised, but the suture material was not found.
I was advised to care for the wound at home using saline and Betadine for cleaning.
After three days of excision, the wound began to shrink, but it continued to produce pus.
On the fifth day after the excision of the granulation tissue, I noticed it had reappeared, causing the drainage hole to stretch.
I returned for another visit and had the granulation tissue excised again.
This process has occurred five times now.
After the fifth excision, gauze (soaked in medication) was packed into the wound, which I removed the next day.
As of March 3, it has been over two months, and this situation continues to repeat itself, causing me great concern.
The doctor is unable to determine the cause, and no ultrasound or similar imaging has been performed; the examination has only been visual with granulation tissue excision.
When will this situation come to an end? Currently, I am unable to return to work.
Please help me with your response.
Thank you.

Ms. Chen, 30~39 year old female. Ask Date: 2006/03/03

Dr. Xie Wenhuai reply Surgery

Due to chronic inflammation of the wound, granulation tissue has formed.
Theoretically, it should be removed for proper healing.
The outpatient physician's approach is correct; however, after multiple debridements without improvement, it is advisable to perform an incision under anesthesia to completely excise the granulation tissue, followed by suturing, which should lead to healing.
I have previously treated a similar situation lasting four months after a cholecystitis surgery, and it was successfully resolved using the same method at this hospital.

Reply Date: 2006/03/03

More Info

Hello, thank you for reaching out regarding your persistent wound issues following your appendicitis surgery. It sounds like you have been through a challenging recovery process, and I understand your concerns about the ongoing drainage and the presence of granulation tissue.

From your description, it appears that you initially underwent an appendectomy due to a ruptured appendix, which led to peritonitis. Post-operative complications such as wound infections and drainage issues are not uncommon, especially in cases involving infection and inflammation. The fact that you experienced significant drainage and the formation of granulation tissue suggests that your body is responding to an ongoing irritation or infection at the surgical site.

Granulation tissue is a normal part of the healing process; however, when it becomes excessive or is associated with drainage, it can indicate that the wound is not healing properly. The presence of yellow fluid suggests that there may still be an infection or that the body is attempting to expel foreign material, such as suture material, which could be contributing to your symptoms.

Here are some considerations and recommendations based on your situation:
1. Infection Management: It is crucial to ensure that any infection is adequately treated. If you have not been on antibiotics recently, it may be worth discussing this with your healthcare provider. They may consider a culture of the drainage to identify any specific pathogens and tailor antibiotic therapy accordingly.

2. Suture Material: If there is a suspicion of suture material being retained or causing irritation, it may be necessary to explore this further. Sometimes, sutures can become encapsulated in tissue, leading to chronic inflammation and drainage. An imaging study, such as an ultrasound or CT scan, could help visualize the area and determine if any foreign material is present.

3. Wound Care: Continue to keep the wound clean and dry. Using saline and antiseptic solutions as you have been doing is appropriate. However, if the wound continues to drain or if you notice increased redness, swelling, or pain, it may require more intensive management.

4. Follow-Up Appointments: It is essential to maintain regular follow-up appointments with your surgeon or healthcare provider. Given that you have already had multiple interventions, it may be beneficial to seek a second opinion if you feel that your concerns are not being adequately addressed.

5. Potential Surgical Intervention: If the drainage and granulation tissue persist despite conservative management, further surgical intervention may be necessary. This could involve excising the granulation tissue and ensuring that the wound is clean and free of any foreign material.

6. Timeframe for Healing: Wound healing can be a slow process, especially in the context of infection and inflammation. It is not uncommon for such wounds to take several weeks or even months to heal completely. However, if you are experiencing significant delays or complications, it is important to advocate for your health and seek further evaluation.

In summary, your ongoing symptoms warrant thorough investigation and management. It is crucial to work closely with your healthcare team to ensure that any underlying issues are addressed and that you receive appropriate treatment. If you continue to experience difficulties, do not hesitate to seek additional opinions or care. Your health and well-being are paramount, and persistent issues like these should be taken seriously.

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