A 58-Year-Old Woman Is Evaluated Due to Increasing Leakage of Fluid

A 58-year-old woman is evaluated due to increasing leakage of fluid from her abdominal incision.  The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for ovarian cancer 5 days ago and initially had a normal postoperative course.  However, after walking the hallway this morning, she had increasing fluid leakage and a bulge at her incision site.  The patient has had no increase in pain and is continuing to tolerate a regular diet and pass flatus.  Temperature is 36.7 C (98.1 F) , blood pressure is 144/92 mm Hg, and pulse is 88/min.  BMI is 40 kg/m².  Palpation of the abdomen shows no rebound or guarding.  The vertical midline abdominal incision has surrounding erythema and a large amount of serosanguineous fluid seeping through the incision.  After some of the skin staples are removed, fatty tissue and a loop of bowel are seen protruding from a separation of the rectus abdominus muscles.  A moist dressing is placed over the wound.  Which of the following is the best next step in management of this patient?

A) Abdominal binder placement
B) CT scan of the abdomen
C) Emergency surgery
D) Negative pressure wound therapy
E) Wound packing with wet-to-dry dressing

Correct Answer:

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