tailieunhanh - Thực hành xử lý sản khoa - Trường hợp 5

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 5', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 40 A 45-year-old woman complains of profuse serosanguinous drainage from her abdominal incision site that has persisted over 4 hr and has soaked several large towels. She had staging surgery for ovarian cancer 7 days previously. 1 ler past medical history is unremarkable. She denies the passage of blood clots or foul smelling lochia. She states that her vaginal bleeding was scant. Her past medical and surgical histories are unremarkable. On examination her weight is 270 lb BP is 100 70 HR 80 min RR 12 min and she is afebrile. The thyroid is normal to palpation. The heart and lung examinations are normal. The remainder of the physical examination is unremarkable except for the abdominal incision. What is the most likely diagnosis What is the most appropriate therapy 32 1 CASE I-ILL S OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 40 Fascial Dehiscence Summary A 45-year-old obese woman complains of a 4-hr history of profuse serosanguinous drainage from her abdominal incision site. She had undergone staging surgery for ovarian cancer 7 days previously. Most likely diagnosis Fascial dehiscence. Most appropriate therapy Immediate surgical closure and broad-spectrum antibiotic therapy. Analysis Objectives 1. Know the classic presentation of fascial dehiscence. 2. Understand that both fascial dehiscence and fascial evisceration are surgical emergencies. 3. Know the risk factors for wound disruptions. Considerations This 45-year-old woman underwent ovarian cancer staging surgery 7 days previously. She now complains of 4 hr of profuse and continuous serosanguinous drainage from her abdominal incision. This is the typical presentation for fascial dehiscence. Because the rectus fascia is interrupted the peritoneal fluid escapes through the wound. If this were only a superficial fascial separation caused by a seroma or other small fluid collection in the subcutaneous fat tissue then the patient would have only complained of a limited amount of drainage. The patient does not .