Post-Laparoscopic Surgical Site Infection Management

Case at a Glance

A 25-year-old female developed a surgical site infection at the umbilical port site following laparoscopic endometriosis excision and bilateral salpingectomy, complicated by underlying connective tissue disorder and postural orthostatic tachycardia syndrome.

Patient's Story

The patient presented with concerns about her surgical recovery one week post-operatively. She reported developing a yellowish discharge with odor from her umbilical incision site, which had progressively worsened over several days. The patient had been unable to shower due to severe orthostatic symptoms limiting her mobility to upper floors of her home. She had been maintaining hygiene with hospital-provided cleansing wipes and washcloths.

Initial Assessment

25-year-old female with medical history significant for postural orthostatic tachycardia syndrome (POTS), hypermobile Ehlers-Danlos syndrome (hEDS), polycystic ovary syndrome (PCOS), and endometriosis. Current medications included ibuprofen, acetaminophen, simethicone, polyethylene glycol, fexofenadine twice daily, vitamin D3, and antibiotics (transitioned from amoxicillin to cephalexin). Physical examination revealed yellowish exudate with malodorous discharge at the umbilical port site.

The Diagnostic Journey

The patient underwent laparoscopic endometriosis excision with ablation and bilateral salpingectomy. Post-operative course was complicated by prolonged hospitalization due to severe dizziness and delayed anesthesia recovery, likely related to her underlying POTS and connective tissue disorder. On post-operative day 4, she noticed yellowish scabbing at the umbilical incision, which progressively developed malodorous drainage by day 7.

Final Diagnosis

Superficial surgical site infection at umbilical laparoscopic port site, post-operative day 7 following gynecologic laparoscopy.

Treatment Plan

Antibiotic therapy was initiated with oral cephalexin following discontinuation of amoxicillin. Local wound care was prescribed consisting of twice-daily cleansing with sterile gauze and hydrogen peroxide. The on-call physician advised emergency department evaluation if symptoms worsened and scheduled follow-up with the primary surgeon. Patient education was provided regarding signs of systemic infection requiring immediate medical attention.

Outcome and Follow-up

Patient was advised to monitor for signs of systemic infection and maintain strict wound hygiene. Follow-up appointment was scheduled with the operating surgeon for wound assessment and antibiotic therapy evaluation. The patient was counseled on the importance of mobility as tolerated to prevent further complications while managing her underlying orthostatic limitations.