II. Approach
- Always call the surgeon when in doubt about a post-surgical patient
- Almost all common surgical complications fit into one of three categories
- Postoperative Infection
- Bleeding
- Damage to adjacent structures
- Timing
- First 24 hours
- First 5-7 days
III. Evaluation
- Common surgical complications should be excluded only after a careful exam and appropriate diagnostic evaluation
- Incision site
- Take off surgical bandages and carefully examine the incision site
- A clean appearing incision site does not exclude deep infection which is a more likely post-surgical infection scenario
-
Cat Scan does not completely exclude serious complications
- Necrotizing infection demonstrates wound site gas in only 50% of cases
- CT Abdomen is typically normal in Bariatric Surgery related Internal Hernia
-
Ultrasound by a skilled operator can identify many post-operative complications
- Ultrasound signs of soft tissue infection with linear probe
- Tissue thickening in the near fields
- Cobblestoning (fluid interspersed with subcutaneous fat)
- Abscess (well demarcated hypoechoic fluid region)
- Ultrasound signs of biliary leak
- Free fluid in region of bile duct suggests bile leak
- Ultrasound signs of soft tissue infection with linear probe
IV. References
- Weinstock in Majoewsky (2012) EM:RAP 12(3): 1-3