Post-Appendectomy Fever: Complications and Care

Recurrent fever after appendectomy?

Hello: My wife experienced abdominal pain on Friday, December 19.
After half a day of observation and an ultrasound examination, she was diagnosed with acute appendicitis and underwent traditional open surgery.
She was discharged on Sunday, December 21.
I have a few questions: 1.
Is it normal for the doctor not to change the dressing on the wound for three days post-surgery before allowing us to be discharged? 2.
Is it normal that we were only given pain medication and gastric medication upon discharge, without any antibiotics? Additionally, as of today, December 31, the drainage tube has not yet been removed (we plan to check the situation tomorrow, January 1).
The patient has been experiencing daily fevers, sometimes reaching over 38 degrees Celsius.
After a second follow-up visit on December 29, the doctor prescribed antibiotics, but the fever persists.
Are these symptoms related? Thank you for your assistance.

leo, 30~39 year old female. Ask Date: 2008/12/31

Dr. Xu Kaixi reply Surgery

Dear Leo,
This is Dr.
Hsu Kai-Hsi from the Department of Surgery at Tainan Hospital, Ministry of Health and Welfare.

Regarding the postoperative dressing changes for acute appendicitis, it depends on the situation.
If the risk of wound infection is low in early acute appendicitis, changing the dressing once or twice a day is sufficient.
The duration of antibiotic treatment will also depend on the severity of the appendicitis and whether there is a rupture.
Generally, at least one day of intravenous antibiotics is administered, and oral antibiotics may not be necessary upon discharge (on the third day).

The removal of the drainage tube is determined by the clinical physician based on the color and amount of the drained fluid.
If there is still fever approximately two weeks post-surgery (from December 19 to December 31) and the drainage tube has not been removed, further evaluation may be necessary, such as a CT scan, to rule out possible intra-abdominal complications (such as intra-abdominal infection or abscess).
Wishing you good health and all the best!
Sincerely,
Dr.
Hsu Kai-Hsi
Department of Surgery
Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2008/12/31

More Info

Post-appendectomy fever can be a concerning symptom for patients and their families. Understanding the potential complications and appropriate care following an appendectomy is crucial for recovery.
1. Wound Care and Dressing Changes: It is not uncommon for surgeons to allow patients to go home without changing the dressing on the surgical site for a few days, especially if the incision appears clean and dry. However, patients should be instructed on how to monitor the wound for signs of infection, such as increased redness, swelling, warmth, or discharge. If the wound appears to be healing well, the surgeon may feel that a dressing change is unnecessary until the follow-up appointment. Nonetheless, if there are any concerns about the wound, patients should not hesitate to contact their healthcare provider for advice.

2. Antibiotic Use: The decision to prescribe antibiotics post-surgery can vary based on the patient's condition and the surgeon's protocol. In many cases, if the surgery was uncomplicated and there are no signs of infection, antibiotics may not be necessary. However, if there are risk factors for infection or if the patient develops a fever, antibiotics may be warranted. It is important to follow up with the healthcare provider if there are ongoing symptoms, such as fever, that do not resolve with the initial treatment.

3. Fever After Surgery: A fever after an appendectomy can be caused by several factors. It may be a normal response to surgery, as the body is healing. However, persistent or high fevers, especially those exceeding 38 degrees Celsius (100.4 degrees Fahrenheit), can indicate complications such as infection, abscess formation, or other postoperative issues. Since your wife has been experiencing daily fevers, it is essential to communicate this to her healthcare provider. The addition of antibiotics after the second visit suggests that the doctor is taking your concerns seriously, but if the fever persists, further evaluation may be necessary.

4. Drainage Tube: The presence of a drainage tube post-surgery is often used to prevent fluid accumulation at the surgical site. The timing for removal can vary based on the amount of drainage and the surgeon's assessment. If the drainage is minimal and the incision is healing well, the tube may be removed sooner. However, if there is significant fluid accumulation or signs of infection, it may need to remain in place longer.

5. Monitoring Symptoms: It is crucial to monitor for any additional symptoms that may arise, such as increased abdominal pain, changes in bowel habits, or any unusual discharge from the surgical site. If your wife experiences any of these symptoms, or if her fever continues despite antibiotic treatment, it is important to seek medical attention promptly.

In summary, while some postoperative fever can be expected, persistent or high fevers warrant further investigation. It is essential to maintain open communication with the healthcare provider and advocate for your wife's health. If symptoms do not improve or worsen, do not hesitate to seek further medical evaluation. Recovery from surgery can be complex, and ensuring that any complications are addressed promptly is key to a successful recovery.

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