Postoperative scar abscess ICD 10

Medical expert article

An abdominal abscess is an inflammation of the abdominal organs of a purulent nature with their further melting and the formation of a purulent cavity of various sizes in them with the presence of a pyogenic capsule. It can form in any part of the abdominal cavity with the formation of a number of clinical syndromes: septic, intoxicating, febrile.

[1], [2], [3], [4], [5], [6]

ICD-10 code

Epidemiology

The number of surgical interventions performed on the abdominal organs is constantly growing. This, the use of a huge number of a wide variety of antibiotics, as well as a strong weakening of the body’s immune system due to rapid urbanization, leads to the frequent development of postoperative abdominal abscesses. According to statistics, postoperative complications in the form of abscess formation develop in 0.8% of patients after planned abdominal surgical interventions and in 1.5% after emergency operations.

[7], [8], [9], [10], [11]

Causes of abdominal abscess

As a rule, abdominal abscesses develop after receiving various injuries, suffering from infectious diseases of the gastrointestinal tract, inflammatory processes in organs located in the abdominal cavity, as well as due to perforation of a defect due to a stomach or duodenal ulcer.

1. Consequence of secondary peritonitis (perforated appendicitis; anastomotic failure after abdominal surgery, pancreatic necrosis after surgery, traumatic injuries), etc.
2. Inflammations of the internal female genital organs of a purulent nature (salpingitis, inflammation of the ovarian appendages, purulent parametritis, pyosalpinxes, tubo-ovarian abscesses).
3. Acute pancreatitis and cholecystitis, nonspecific ulcerative colitis.

Spinal osteomyelitis, spondylitis of tuberculous etiology, inflammation of the perinephric tissue.

The main causative agents of abscesses are aerobic (Escherichia coli, Proteus, Staphylococcus and Streptococcus, etc.) and anaerobic (Clostridium, Bacteroides fragilis, Fusobacteriales) bacterial flora.

[12], [13], [14], [15], [16], [17]

Risk factors

Very often, abscesses of the abdominal organs develop as a result of surgical interventions on the abdominal organs (most often, after operations on the bile ducts of the pancreas, intestines). There are cases when the peritoneum becomes infected after the intervention, especially when the anastomosis fails.

In 70% of cases, the abscess develops in the intraperitoneal or retroperitoneal region, in 30% it is localized inside an organ.

[18], [19], [20], [21], [22], [23], [24], [25], [26], [27]

Pathogenesis

An abdominal abscess develops as a result of hyperreactivity of the immune system with the active growth and reproduction of streptococcal and staphylococcal flora, as well as E. coli (appendicular abscess). Pathogens enter the abdominal cavity through the lymphogenous or hematogenous route, as well as through contact through the fallopian tubes when destructive inflammation of an organ or organ occurs, injury, perforation, or failure of sutures that were placed during surgery.

The main difference between an abdominal abscess is the fact that the source of inflammation is clearly limited from the healthy tissue that surrounds it. If the pyogenic membrane is destroyed, sepsis and purulent leaks develop. Ulcers can be either single or numerous.

[28], [29], [30], [31], [32], [33], [34]

Symptoms of an abdominal abscess

The first signs of an abdominal abscess vary, but in most cases patients experience:

1. Severe fever, chills, which is accompanied by mild pulling sensations in the abdominal area, which intensify with palpation.
2. Frequent urge to urinate (since the abdominal cavity is located close to the bladder.
3. Constipation.
4. Nausea, which may be accompanied by vomiting.

Also, other objective symptoms of an abdominal abscess are:

1. Tachycardia, high blood pressure.
2. Tension of the muscles of the anterior abdominal wall.

If the abscess is subphrenic, then the main symptoms also include:

1. Pain in the hypochondrium area, which may intensify during inhalation and radiate to the scapula.
2. By changing the patient's walking, he begins to tilt his torso in the direction of discomfort.
3. High body temperature.

[35], [36], [37], [38], [39], [40], [41], [42]

Complications and consequences

If an abdominal abscess is not diagnosed on time and proper treatment is not started, quite serious consequences can occur:

That is why, if you feel any discomfort or pain in the abdominal area, you should immediately seek help from a gastroenterologist or therapist.

[43], [44], [45], [46], [47], [48], [49], [50]

Diagnosis of abdominal abscess

The main diagnostic methods are:

1. X-ray of the chest and abdominal cavity.
2. Ultrasonography.
3. CT and MRI as auxiliary diagnostic methods.
4. Taking a puncture from the posterior vaginal fornix or anterior wall of the rectum (if there is a suspicion of the development of a zone of Douglas abscess).

[51], [52], [53], [54], [55], [56], [57], [58]

Analyzes

If an abscess cannot be diagnosed due to the absence of any symptoms, tests may be prescribed, including a complete blood count. With this disease, the patient almost always experiences leukocytosis, sometimes neutrophyllosis (a sharp shift in the leukocyte count to the left), as well as an increase in ESR.

[59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71]

Instrumental diagnostics

Using an x-ray of the chest organs, you can notice that on the affected side the dome of the diaphragm is high. A reactive effusion can be seen in the pleural zone. With a subdiaphragmatic abscess, X-ray images show a gas bubble and a fluid level underneath it.

Ultrasound signs of an abdominal abscess

The “golden” standard for diagnosing abdominal abscesses of various locations is ultrasound. Ultrasound signs are: a clearly defined liquid formation in the capsule, the contents of which are heterogeneous and have the appearance of a thread-like structure or an echogenic suspension. There is a so-called reverberation effect due to gases, when multiple reflections of sound gradually reduce its intensity.

Treatment of abdominal abscess

Treatment consists of surgery to remove the abscess and drain it using a catheter.

Drug treatment cannot cure an abdominal abscess, but various antibiotics can limit the spread of infection. That is why doctors prescribe them to patients before and after surgery. Preferably drugs that can suppress the development of intestinal microflora are used. In some cases, antibiotics that are active against anaerobic bacteria, including Pseudormonas, are also recommended.

Medicines

Metronidazole. An effective antimicrobial and antiprotozoal agent. The medicine contains the active substance metronidazole. It is capable of reducing the 5-nitro group with intracellular proteins in protozoa and anaerobic bacteria. After restoration, this nitro group interacts with the DNA of bacteria, as a result of which the synthesis of nucleic acids of pathogens is inhibited and they die.

Metronidazole is effective against amoebas, trichomonas, bacteroides, peptococci, fusobacteria, eubacteria, peptostreptococci and clostridia.

Metronidazole has high absorption and effectively penetrates the affected tissues and organs. The dosage is individual and is set by the attending physician depending on the patient’s condition. Patients with intolerance to metronidazole, a history of epilepsy, diseases of the central and peripheral nervous system, leukopenia, and abnormal liver function are prohibited from using the drug. Also should not be prescribed during pregnancy.

In some cases, the use of the drug can cause: vomiting, anorexia, diarrhea, glossitis, pancreatitis, migraines, vertigo, depression, allergies, dysuria, polyuria, candidiasis, frequent urination, leukopenia.

Prevention

Preventive measures are based on adequate and timely treatment of various diseases of the organs located in the abdominal cavity. It is also very important to make a correct diagnosis in time for acute appendicitis and perform surgery to remove it.

[72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84]

Local complications. Complications in the area of ​​the surgical wound include bleeding, hematoma, infiltration, suppuration of the wound, separation of its edges with prolapse of the viscera (eventration), ligature fistula, seroma.

Bleeding can occur as a result of insufficient hemostasis during surgery, slipping of the ligature from the vessel, or a blood clotting disorder. Stopping bleeding is carried out by known methods of final hemostasis (cold application to the wound, tamponade, ligation, hemostatic drugs), and repeated surgical intervention performed for this purpose.

A hematoma forms in tissues from blood coming from a bleeding vessel. It dissolves under the influence of heat (compress, ultraviolet irradiation (UVR)), and is removed by puncture or surgery.

Infiltrate - this is the impregnation of tissues with exudate at a distance of 5-10 cm from the edges of the wound. The reasons are infection of the wound, traumatization of the subcutaneous fat tissue with the formation of areas of necrosis and hematomas, inadequate drainage of the wound in obese patients, and the use of material with high tissue reactivity for sutures on the subcutaneous fat tissue. Clinical signs of infiltration appear on the 3rd - 6th day after surgery: pain, swelling and hyperemia of the edges of the wound, where a painful compaction without clear contours is palpable, deterioration in general condition, increased body temperature, and the appearance of other symptoms of inflammation and intoxication. Resorption of the infiltrate is also possible under the influence of heat, so physiotherapy is used.

Wound suppuration develops for the same reasons as infiltration, but the inflammatory phenomena are more pronounced. Clinical signs appear towards the end of the first - beginning of the second day after surgery and progress in the following days. Within several days the patient's condition approaches septic. If the wound suppurates, you need to remove the stitches, separate its edges, release the pus, sanitize and drain the wound.

Eventration - protrusion of organs through a surgical wound - can occur for various reasons: due to deterioration of tissue regeneration (with hypoproteinemia, anemia, vitamin deficiency, exhaustion), insufficiently strong suturing of tissues, suppuration of the wound, a sharp and prolonged increase in intra-abdominal pressure (with flatulence, vomiting, cough, etc.).

The clinical picture depends on the degree of eventration. Prolapse of the viscera most often occurs on the 7-10th day or earlier with a sharp increase in intra-abdominal pressure and is manifested by the divergence of the edges of the wound, the exit of organs through it, which can result in the development of their inflammation and necrosis, intestinal obstruction, and peritonitis.

During eventration, the wound should be covered with a sterile bandage moistened with an antiseptic solution. In the operating room under general anesthesia, the surgical field and prolapsed organs are treated with antiseptic solutions; the latter are straightened, the edges of the wound are tightened with strips of plaster or strong suture material and reinforced with tight abdominal bandaging and a tight bandage. The patient is prescribed strict bed rest for 2 weeks and stimulation of intestinal activity.

Ligature fistula appears as a result of infection of non-absorbable suture material (especially silk) or individual intolerance to the suture material by the macroorganism. An abscess forms around the material, which opens in the area of ​​the postoperative scar.

The clinical manifestation of a ligature fistula is the presence of a fistula tract through which pus is released with pieces of the ligature.

In case of multiple fistulas, as well as a long-lasting single fistula, an operation is performed - excision of the postoperative scar with the fistula tract. After removing the ligature, the wound heals quickly.

Seroma - accumulation of serous fluid - occurs due to the intersection of lymphatic capillaries, the lymph of which collects in the cavity between the subcutaneous fatty tissue and the aponeurosis, which is especially pronounced in obese people in the presence of large cavities between these tissues.

Clinically, seroma is manifested by the discharge of straw-colored serous fluid from the wound.

Treatment of seroma, as a rule, is limited to one or two evacuation of this wound discharge in the first 2 to 3 days after surgery. Then the formation of seroma stops.

Such complications arise as a result of the general impact of surgical trauma on the body and are manifested by dysfunction of organ systems.

Most often after surgery, pain is observed in the area of ​​the postoperative wound. To reduce it, narcotic or non-narcotic analgesics with analeptics are prescribed for 2 - 3 days after surgery or a mixture of antispasmodics with analgesics and desensitizing agents.

Complications from the nervous system. Insomnia is often observed after surgery, and mental disorders are much less common. For insomnia, sleeping pills are prescribed. Mental disorders occur in weakened patients and alcoholics after traumatic operations. If psychosis develops, an individual post should be established and the doctor on duty or a psychiatrist should be called. To calm patients, thorough anesthesia is performed and antipsychotics (haloperidol, droperidol) are used.

Respiratory complications. Bronchitis, postoperative pneumonia, and atelectasis occur as a result of impaired ventilation of the lungs, hypothermia, and most often develop in smokers. Before surgery and in the postoperative period, patients are strictly prohibited from smoking. To prevent pneumonia and atelectasis, patients are given breathing exercises, vibration massage, chest massage, cupping and mustard plasters, oxygen therapy, and a semi-sitting position in bed. Hypothermia must be avoided. To treat pneumonia, antibiotics, cardiac drugs, analeptics and oxygen therapy are prescribed. If severe respiratory failure develops, a tracheostomy is applied or the patient is intubated with breathing apparatus connected.

Most dangerous Acute cardiovascular failure - left ventricular or right ventricular. With left ventricular failure, pulmonary edema develops, characterized by the appearance of severe shortness of breath, fine wheezing in the lungs, increased heart rate, a drop in arterial pressure and an increase in venous pressure. To prevent these complications, it is necessary to carefully prepare patients for surgery, measure blood pressure, pulse, and administer oxygen therapy. As prescribed by the doctor, cardiac medications (corglycon, strophanthin), antipsychotics are administered to adequately replenish blood loss.

Acute Thrombosis and embolism develop in severely ill patients with increased blood clotting, the presence of cardiovascular diseases, and varicose veins. In order to prevent these complications, the legs are bandaged with elastic bandages and the limbs are placed in an elevated position. After the operation, the patient should begin to walk early. As prescribed by the doctor, antiplatelet agents (reopolyglucin, trental) are used; if blood clotting increases, heparin is prescribed under the control of clotting time or low molecular weight heparins (fraxiparin, clexane, fragmin), and coagulogram parameters are examined.

Complications from the digestive system. Due to insufficient oral care, stomatitis (inflammation of the oral mucosa) and acute parotitis (inflammation of the salivary glands) can develop, therefore, to prevent these complications, thorough oral hygiene is necessary (rinsing with antiseptic solutions and treating the oral cavity with potassium permanganate, using chewing gum or lemon slices to stimulate salivation).

A dangerous complication is paresis of the stomach and intestines, which can manifest itself as nausea, vomiting, flatulence, and non-excretion of gases and feces. For the purpose of prevention, a nasogastric tube is inserted into the patient's stomach, the stomach is washed and the gastric contents are evacuated, and Cerucal or Raglan is administered parenterally from the first days after surgery. A gas outlet tube is inserted into the rectum, and in the absence of contraindications, a hypertensive enema is used. To treat paresis, as prescribed by a doctor, prozerin is administered to stimulate the intestines, hypertonic solutions of sodium and potassium chlorides are administered intravenously, an Ognev enema is used (10% sodium chloride solution, glycerin, hydrogen peroxide 20.0 ml), perinephric or epidural blockade, and hyperbaric therapy are performed.

Complications from the genitourinary system. The most common symptoms are urinary retention and bladder overflow. In this case, patients complain of severe pain above the womb. In these cases, it is necessary to induce urination with the sound of a falling stream of water and apply heat to the pubic area. If there is no effect, catheterization of the bladder is performed with a soft catheter.

To prevent urinary retention, the patient should be taught to urinate in a duck while lying in bed before surgery.

Skin complications. Bedsores more often develop in exhausted and weakened patients, with a long-term forced position of the patient on his back, trophic disorders due to damage to the spinal cord. Prevention requires careful skin care, an active position in bed or turning the patient over, and timely change of underwear and bed linen. Sheets should be free of wrinkles and crumbs.

Cotton-gauze rings, a backing circle, and an anti-decubitus mattress are effective. When bedsores occur, chemical antiseptics (potassium permanganate), proteolytic enzymes, wound healing agents, and excision of necrotic tissue are used.

Timing for suture removal.

The timing of suture removal is determined by many factors: the anatomical region, its trophism, the regenerative characteristics of the body, the nature of the surgical intervention, the patient’s condition, his age, the characteristics of the disease, the presence of local complications of the surgical wound.

When a surgical wound heals by primary intention, the formation of a postoperative scar occurs on the 6th - 16th day, which allows the sutures to be removed within these periods.

So, sutures are removed after operations:

• on the head - on the 6th day;

• associated with a small opening of the abdominal wall (appendectomy, herniotomy) - on the 6th - 7th day;

• requiring a wide opening of the abdominal wall (laparotomy or transection) - on days 9-12;

• on the chest (thoracotomy) - on the 10-14th day;

• after amputation - on the 10-14th day;

• in elderly, weakened and cancer patients due to reduced regeneration - on the 14th-16th day.

Sutures placed on the skin and mucous membranes can be removed by a nurse in the presence of a doctor. The sutures are removed using scissors and tweezers. Using tweezers, grab one of the ends of the knot and pull it in the opposite direction along the suture line until a white piece of ligature appears from the depths of the tissue. In the area of ​​the white segment, the thread is crossed with scissors. The removed threads are thrown into a tray or basin. The area of ​​the postoperative scar is treated with a 1% iodonate solution and covered with a sterile bandage.

Complications of procedures not elsewhere classified (T81)

1. abnormal reaction to a drug NOS (T88.7) complication associated with:

1. immunization (T88.0-T88.1) infusion, transfusion and therapeutic injection (T80.-)

specified complications classified elsewhere, such as:

1. complications caused by orthopedic devices, implants and grafts (T82-T85) dermatitis caused by drugs and medications (L23.3, L24.4, L25.1, L27.0-L27.1) failure and rejection of transplanted organs and tissues ( T86) poisoning and toxic effects of drugs and chemicals (T36-T65)

Bleeding of any location resulting from the procedure

1. obstetric wound hematoma (O90.2) bleeding caused by orthopedic devices, implants and grafts (T82.8, T83.8, T84.8, T85.8)

1. Collapse NOS during or after procedure Shock (endotoxic) (hypovolemic) during or after procedure Postoperative shock NOS

Use additional code (K57.2) if desired to identify septic shock

1. anesthesia-induced (T88.2) anaphylactic:

1. NOS (T78.2) conditioned by:

1. adequately prescribed and correctly administered drug (T88.6) serum administration (T80.5)

from exposure to electric current (T75.4) complicating abortion, ectopic or molar pregnancy (O00-O07, O08.3) obstetric (O75.1) traumatic (T79.4)

T80 Complications associated with infusion, transfusion and therapeutic injection

1. T80.0 Air embolism associated with infusion, transfusion, and therapeutic injection
2. T80.1 Vascular complications associated with infusion, transfusion and therapeutic injection
3. T80.2 Infections associated with infusion, transfusion and therapeutic injection
4. T80.3 Reactions to ABO incompatibility
5. T80.4 Reactions to Rh incompatibility
6. T80.5 Anaphylactic shock associated with serum administration
7. T80.6 Other serum reactions
8. T80.8 Other complications associated with infusion, transfusion and therapeutic injection
9. T80.9 Complication related to infusion, transfusion and therapeutic injection, unspecified

T81 Complications of procedures not elsewhere classified

1. T81.0 Bleeding and hematoma complicating the procedure, not classified elsewhere
2. T81.1 Shock during or after procedure, not elsewhere classified
3. T81.2 Accidental puncture or rupture during a procedure, not elsewhere classified
4. T81.3 Dehiscence of the edges of the surgical wound, not classified elsewhere
5. T81.4 Infection associated with a procedure, not elsewhere classified
6. T81.5 A foreign body accidentally left in a body cavity or surgical wound during a procedure
7. T81.6 Acute reaction to a foreign substance accidentally left during the procedure
8. T81.7 Vascular complications associated with the procedure, not elsewhere classified
9. T81.8 Other complications of procedures not classified elsewhere
10. T81.9 Unspecified complication of the procedure

T82 Complications associated with cardiac and vascular devices, implants and grafts

1. T82.0 Mechanical complication associated with a prosthetic heart valve
2. T82.1 Complication of mechanical origin associated with electronic cardiac pacemaker
3. T82.2 Complication of mechanical origin associated with arterial shunt of the heart valves
4. T82.3 Complication of mechanical origin associated with other vascular grafts
5. T82.4 Mechanical complication associated with a vascular dialysis catheter
6. T82.5 Complication of mechanical origin associated with other cardiac and vascular devices and implants
7. T82.6 Infection and inflammatory response associated with a prosthetic heart valve
8. T82.7 Infection and inflammatory response associated with other cardiac devices, implants, and grafts
9. T82.8 Other complications associated with cardiac and vascular prostheses, implants and transplants
10. T82.9 Complication associated with cardiac and vascular prosthesis, implant and graft, unspecified

T83 Complications associated with genitourinary prosthetic devices, implants and grafts

1. T83.0 Complication of mechanical origin associated with an indwelling urinary catheter
2. T83.1 Complication of mechanical origin associated with other urinary devices and implants
3. T83.2 Complication of mechanical origin associated with urinary organ transplant
4. T83.3 Complication of mechanical origin associated with an intrauterine contraceptive device
5. T83.4 Complication of mechanical origin associated with other prosthetic devices, implants and grafts
6. T83.5 Infection and inflammatory response due to prosthetic device, implant and graft in the urinary system
7. T83.6 Infection and inflammatory reaction caused by prosthetic device, implant and graft in the genital tract
8. T83.8 Other complications associated with genitourinary prosthetic devices, implants and grafts
9. T83.9 Complications related to genitourinary prosthetic device, implant and graft, unspecified

T84 Complications associated with internal orthopedic prosthetic devices, implants and grafts

1. T84.0 Complication of mechanical origin associated with internal joint prosthesis
2. T84.1 Complication of mechanical origin associated with the internal device that fixes the bones of the limb
3. T84.2 Complication of mechanical origin associated with the internal device that fixes other bones
4. T84.3 Complication of mechanical origin associated with other bone devices, implants and grafts
5. T84.4 Complication of mechanical origin associated with other internal orthopedic devices, implants and grafts
6. T84.5 Infection and inflammatory reaction caused by endoprosthetics
7. T84.6 Infection and inflammatory reaction caused by an internal fixation device of any location
8. T84.7 Infection and inflammatory reaction due to other internal orthopedic prosthetic devices, implants and grafts
9. T84.8 Other complications associated with internal orthopedic prosthetic devices, implants and grafts
10. T84.9 Complications associated with internal orthopedic prosthetic device, implant and graft, unspecified

T85 Complications associated with other internal prosthetic devices, implants and grafts

1. T85.0 Complication of mechanical origin associated with intracranial ventricular shunt coupling
2. T85.1 Complication of mechanical origin associated with an implanted electronic nervous system stimulator
3. T85.2 Complication of mechanical origin associated with the artificial lens of the eye
4. T85.3 Complication of mechanical origin associated with other ocular prostheses, implants and grafts
5. T85.4 Complication of mechanical origin associated with prosthesis and breast implant
6. T85.5 Complication of mechanical origin associated with gastrointestinal prosthesis, implant and graft
7. T85.6 Complication of mechanical origin associated with other specified internal prosthetic devices, implants and grafts
8. T85.7 Infection and inflammatory reaction caused by other internal prosthetic devices, implants and grafts
9. T85.8 Other complications associated with internal prosthetic devices, implants and grafts, not elsewhere classified
10. T85.9 Complication related to internal prosthetic device, implant and graft, unspecified

T86 Death and rejection of transplanted organs and tissues

1. T86.0 Bone marrow transplant rejection
2. T86.1 Death and rejection of the kidney transplant
3. T86.2 Heart transplant death and rejection
4. T86.3 Death and rejection of cardiopulmonary transplant
5. T86.4 Liver transplant death and rejection
6. T86.8 Death and rejection of other transplanted organs and tissues
7. T86.9 Death and rejection of transplanted organ and tissue, unspecified

T87 Complications characteristic of replantation and amputation

1. T87.0 Complications associated with replantation of part of the upper limb
2. T87.1 Complications associated with replantation of a part of the lower limb
3. T87.2 Complications associated with replantation of other body parts
4. T87.3 Amputation stump neuroma
5. T87.4 Amputation stump infection
6. T87.5 Necrosis of the amputation stump
7. T87.6 Other and unspecified complications of amputation stump

T88 Other complications of surgical and therapeutic interventions, not elsewhere classified

1. T88.0 Immunization-associated infection
2. T88.1 Other immunization-related complications not elsewhere classified
3. T88.2 Shock caused by anesthesia
4. T88.3 Anesthesia-induced malignant hypothermia
5. T88.4 Unsuccessful or difficult intubation
6. T88.5 Other complications of anesthesia
7. T88.6 Anaphylactic shock caused by a pathological reaction to an adequately prescribed and correctly administered drug
8. T88.7 Pathological reaction to a drug or drugs, unspecified
9. T88.8 Other specified complications of surgical and therapeutic interventions, not classified elsewhere
10. T88.9 Unspecified complication of surgical and therapeutic intervention