A 65 year old man has pain in his abdomen and is seen on the surgical inpatient ward. He had a closure of his colostomy 5 days ago.
His temperature is 36.5°C, pulse rate is 76 bpm, BP 124/82 mmHg and respiratory rate is 15 breaths per minute. There is a tender, localised fluctuant swelling 4 cm in diameter in the wound.
Which is the most appropriate management?
- Abdominal support
- Antibiotics
- Laparotomy
- Local exploration of wound
- Observation
D. Local exploration of wound
Explanation:
Diagnosis is a wound abscess following closure of colostomy. Wound exploration and washout would be first line of treatment. Antibiotics alone would likely be insufficient alone to treat an abdominal wound abscess although should also be given whilst waiting for exploration. Observation is not adequate. The patient is not septic and has no indications of an acute abdomen suggesting an intrabdominal cause and thus requiring laparotomy. Abdominal support is not a treatment for abscess.