Wound Abscess after Cesarian Delivery

The correct answer is D.

This patient most likely has a wound abscess. When antibiotic prophylaxis is used, wound infections occur at a rate of approximately 1% after cesarean deliveries. However, this patient appears to have more than a cellulitis. The fluctuant mass at the leftmost aspect of the incision is highly likely to be an abscess. The proper treatment for a wound abscess is with incision and drainage.

This patient is unlikely to improve with expectant management (choice A). An abscess almost always requires incision and drainage for cure. Expectant management may lead to worsening of the infection, with the possibility of spread to adjacent structures (e.g., fascia) or to bacteremia and sepsis.

Oral antibiotics only (choice B) or IV antibiotics only (choice C) may not resolve the abscess. Antibiotics often do not penetrate the abscess cavity.

Laparotomy (choice E) is probably not necessary for this patient. She has a wound abscess that should be addressed with incision and drainage. In the process of the incision and drainage, the fascia should be checked to ensure that it is intact. As long as the fascia is intact and there is no intra-abdominal process, there is no need for laparotomy.

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