A 65-year-old male undergoes an uncomplicated open sigmoid colectomy for colon adenocarcinoma. On postoperative day 5, he develops a temperature of 38.6°C. The surgical midline incision is erythematous, warm, exquisitely tender, and oozing cloudy serosanguinous discharge. What is the diagnosis and primary surgical management?

Answer and explanation

Correct answer: B. Surgical Site Infection (SSI); open wound and evacuate purulent fluid

  1. Step 1: Fever occurring on postoperative day 5 to 7 combined with localized erythema, wound warmth, tenderness, and purulent discharge is diagnostic of a Surgical Site Infection (SSI).
  2. Step 2: The definitive surgical management is opening the skin and subcutaneous incision along the affected length, releasing sutures/staples, irrigating and evacuating collected hematoma or pus, taking swabs for culture, and packing with saline-moistened sterile gauze for secondary intention healing.
  3. Step 3: Systemic antibiotics are added if systemic signs or spreading cellulitis are present.
Answer
Surgical Site Infection (SSI); open wound and evacuate purulent fluid.
Why not the others: 'Atelectasis' causes early fever on postoperative days 1 to 2; 'Deep vein thrombosis' causes unilateral calf swelling and fever on days 7 to 10; 'Reassurance' allows progressive necrotizing fasciitis or wound dehiscence.

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