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POST OPERATIVE COMPLICATIONS

TYPE OF POST OPERATIVE COMPLICATIONS

  1. General complications
  2. Specific complications
  3. Wound problems

GENERAL COMPLICATIONS

FEVER : It can be caused by following reasons:

A. PNEUMONIA:

  • It can occur as a complication usually 48 hours onwards.
  • Patient present with cough , fever, sob
  • Investigation: CXR
  • Rx: Antibiotics (amoxicillin)

B. URINARY TRACT INFECTION:

  • Usually secondary to catheterization
  • In elderly patient it can cause dysuria, frequency
  • Investigation: MSU
  • Rx: antibiotics (Trimethoprim)

C. ATELECTASIS:

  • Lung collapse.
  • Common in people who smoke.
  • Presentation: Chest pain and mild fever.
  • Usually occurs within first 48 hours after an operation which is close to the lung especially splenectomy.
  • Investigations: CXR to R/O pneimonia.
  • Rx: Physiotherapy.

D. WOUND INFECTION:

  • Usually after 5 days post operative.
  • Patient present with discharge from the wound, redness & tenderness around the wound.
  • Investigations: wound swab, microscopy, culture and sensitivity.
  • Rx: Antibiotics

E. INTRA-ABDOMINAL ABSCESS:

  • Subphrenic abscess or sub hepatic abscess
  • Usually after 5 days post operative.
  • Patient presents with swinging fever.
  • Investigations: CT abdomen
  • Rx: Incision & drainage

F. ANASTOMOTIC LEAK:

  • Usually after bowel resection
  • Any physiological change after bowel resection is alwys anastomotic leak until proven otherwise.
  • Never occur immediately after operation but after patient starts eating and drinking, usually 3-7 post operative day.
  • Investigation: CT abdomen
  • Rx: Antibiotics: IV immediately (cefuroxime+metronidazole)
  • Laparotomy is the definitive treatment.

INTRA-ABDOMINAL BLEED: 

  • Usually few hours after surgery
  • Management : Laparotomy

CONFUSION: It can be caused by:

A. INFECTION:

  • UTI
  • Pneumonia
  • usually in elderly and after 5 post operative day

B. MEDICATIONS:

  • Opiate usually used during an operation

HYPOXIA/ SOB /DYSPNOEA:

A. PULMONARY EMBOLISM : chest pain, hamoptysis, 5 days onwards after an operation

B. PULMONARY OEDEMA: Post operative pulmonary oedema is almost always due to fluid overload.

C. PNEUMONIA

D. PNEUMOTHORAX:

  • Usually occurs due to ventilation pressure especially if there was a small pneumothorax.
  • Chest drain must be inserted if it is small.

E. MYOCARDIAL INFARCTION:

  • Patient presents with chest pain radiating to the left arm.

HYPOTENSION:

A. BLEEDING: IV Fluid

OTHER MEDICAL CONDITIONS : MI, PE or Sepsis

OLIGURIA:

  • Post operative oliguria is almost secondary to inadequate fluid replacement.
  • Rx: IV Fluid

ANURIA:

  • Almost always due to blocked cathter
  • Check catheter

POSTOPERATIVE HYPONATRAEMIA:

A. SIADH: especiall after brain surgery

B. Over hydration, especially with colloids because sodium gets diluted.

DEEP VENOUS THROMBOEMBOLISM:

  • Pteinets usually present with unilateral calf swelling, pitting oedema, calf pain.
  • In post-operative patients we do not use D-dimer as an investigation. But the investigation of choice is always a Compression Ultrasound Scan.

 

          SPECIFIC POST-OPERATIVE COMPLICATIONS

1. MASTECTOMY:

  • Common complication in lymphoedema (arm becomes swollen)
  • Rx: Physiotherapy and arm exercise.

2. THYROIDECTOMY:

A. RECURRENT LARYNGEAL NERVE PALSY:

  • Patient presents with hoarseness of voice.
  • Usually resolves after 2-3 weeks if unilateral so just reassure.
  • If bilateral , needs surgical airway.

 

B. TRACHEAL OBSTRUCTION BY HAEMATOMA:

  • Usually presents with acute shortness of breath and stridor immediately after operation.
  • Commonly seen when patient is still in recovery room
  • Rx: release the stitches on the bedside

C. HYPOCALCAEMIA:

  •  Usually due to injury  or aberrant removal of parathyroid glands during surgery.
  • Patient presents with tetani, Chvostek sign and Troseau’s sign (carpopedal spasm), muscle irritability.

 

3. POST TURP SYNDROME:

  • The irrigation fluid used to visualize and distend the urethra and bladder gains intravascular access through the venous circulation causing dilutional hyponatremia.
  • Rx: Fluid restriction.

4. APPENDICECTOMY:

  • Common complication is abdominal and pelvic abscess especially if it is perforated  or gangrenous appendicitis.
  • Usually patient will have swinging fever
  • Investigations: CT scan abdomen or abdominal ultrasound
  • Rx: I & D

5. SPLENECTOMY:

  • Spleen takes part in immune system so splenectomy cause low immune funtion and patient will have recurrent infections.
  • Prophylaxis vaccine is required against following infections:

– Pneumococcal

-Meningococcal

– Haemophilus influenza

  • Patient also requires long term antibiotics prophylaxis.

6. ABDOMINAL SURGERY:

A. PARALYTIC ILEUS:

  • Usually presents  with abdominal distention, constipation, vomiting and reduced bowel sounds.
  • Occurs few days after  the operation
  • No abdominal pain
  • Investigation: Plain abdominal X-ray  shows dilated bowel loops
  • Management: Nasal gastric tube and intravenous fluid.

B. OBSTRUCTION SECONDARY TO ADHESIONS:

  • This will occur after weeks, months or years
  • Cardinal symptoms: Abdominal pain, vomiting , constipation, abdmoinal distension and increased bowel sounds

7. ERCP:

A. ACUTE PANCREATITIS

B. CHOLANGITIS

 

WOUND INFECTION

  • Wound swelling , bleeding or discharge needs inspection/ exploration of the wound

1. LAPAROTOMY WOUND DEHISCENCE:

  • Dehiscence of laparotomy wound is spontaneous opening of deep suture layers with or without superficial layer.
  • Presents with serosanuinous discharge from wound and usually 7-10 days post operative.
  • Rx: Resuture wound

2. WOUND BLEEDING:

  • Usually bleeding is minor and settles spontaneously.
  • Presents with oozing wound, haematoma on palpation.
  • Rx: If minor bleeding, try gentle pressure for 5 minutes. If ongoing large amount of bleeding, patient may need to go to theatre

3. SUPERFICIAL WOUND INFECTION AND ABSCESS:

  • Present with wound pain, pyrexia, pus like discharge
  • Rx: Inspection/ exploration of wound
  • If temperature >37.5, take blood cultures, CRP, FBC, U& E.
  • If abscess: wound drainage, take swab for microscopy, culture & sensitivity.
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