Question

CASE STUDY 2

Peter a 46-year-old salesperson with obesity and poorly controlled Type 2 Diabetes Mellitus underwent scheduled laparoscopic gastric bypass surgery.

Peter was brought to the operating room at 08:58 am. The first laparoscope trocar was inserted into the abdomen with some unexpected resistance, but there was no apparent injury sustained. Three additional laparoscope trocars were inserted into the abdomen and the procedure was completed when the last of the 4 laparoscope trocar incisions was closed. The patient was transferred to the Intensive Care Unit in a stable condition. At 18:00, he was awake and responsive with patient-controlled pain management and a temperature of 37.5°C.

At 03:15 am the following day, Peter complained of severe pain around the area close to the insertion site of the first trocar. He had a temperature of 38.6°C. The medical intern ordered blood and urine cultures, and a scan. The scan, performed at 03:50 am, revealed free fluid close to the large intestine. The patient reported that the pain had increased and had spread across his abdomen. By 04:00 am, his temperature had reached 40°C, and he was returned to the operating room. An exploratory emergency laparotomy performed at the site of the primary incision revealed a perforated large intestine (also known as perforated viscus) and faecal material in the abdomen. The tissues were inflamed, and small amounts of pus were seen. The abdomen was washed out, and the perforation was repaired. Once the incision was closed, the patient was returned to the Intensive Care Unit where he was treated with a number of different I.V. antibiotics.

Question 1:

Consulting the Antibiotic Therapeutic Guidelines, select a course of suitable intravenous antibiotics for Peter and justify (explain) why this selection is the best option for Peter.

Include dosing information

Answer 1

Answer :

Exploratory laparotomy is a surgical incision into the abdominal cavity .

This operation is performed to examine the abdominal organs and aid diagnosis of any problems including abdominal pain .

Treatment :

Principles of antibiotic usage:

• Treatment and prevention of infection is a cardinal responsibility of surgical team.
• Favourable outcome of surgeries were recorded with appropriate use of antibiotics .
• SSI increase mortality, morbidity ,hospital stay and cost of treatment .
• Inj. Cefazolin + metronidazole can be recommended drug of choice for the prevention of postoperative infection .
• Clindamycin + aminoglycosides are the alternative regimen for the abdominal surgeries .
• Inj . Clindamycin for the severe post operative infection.
• Inj. Ranitidine 50 mg as a anti histamic action.
• Inj. Diclofenac as a pain killer .