Post-Surgical Pitfalls

Aka: Post-Surgical Pitfalls, Postoperative Pitfalls, Surgical BounceBacks

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II. Approach

  1. Always call the surgeon when in doubt about a post-surgical patient
  2. Almost all common surgical complications fit into one of three categories
    1. Postoperative Infection
    2. Bleeding
    3. Damage to adjacent structures
  3. Timing
    1. First 24 hours
      1. Necrotizing Soft Tissue Infections
    2. First 5-7 days
      1. Abscess following appendectomy
      2. Leaks from an anastomosis
      3. Breast biopsy Hematoma

III. Evaluation

  1. Common surgical complications should be excluded only after a careful exam and appropriate diagnostic evaluation
  2. Incision site
    1. Take off surgical bandages and carefully examine the incision site
    2. A clean appearing incision site does not exclude deep infection which is a more likely post-surgical infection scenario
  3. Cat Scan does not completely exclude serious complications
    1. Necrotizing infection demonstrates wound site gas in only 50% of cases
    2. CT Abdomen is typically normal in Bariatric Surgery related Internal Hernia
  4. Ultrasound by a skilled operator can identify many post-operative complications
    1. Ultrasound signs of soft tissue infection with linear probe
      1. Tissue thickening in the near fields
      2. Cobblestoning (fluid interspersed with subcutaneous fat)
      3. Abscess (well demarcated hypoechoic fluid region)
    2. Ultrasound signs of biliary leak
      1. Free fluid in region of bile duct suggests bile leak

IV. References

  1. Weinstock in Majoewsky (2012) EM:RAP 12(3): 1-3

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