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Home | Articles | General Surgery | Surgical Post-operative Complications

Surgical Post-operative Complications

Last updated 14th May 2021

Bleeding

  1. Classified into 3 main categories
    • Primary bleeding – bleeding that occurs within the intra-operative period and should be resolved during the operation
    • Reactive bleeding – occurs within 24 hours of operation. Most cases are from ligature that has slipped or a missed vessel
    • Secondary bleeding – occurs 7-10 days post-operatively. Often due to erosion of vessel from a spreading infection
  2. Presentation
    Tachycardia, tachypnoea (most sensitive sign), hypotension (often a late sign), dizziness, visible bleeding, decreased urine output
  3. Management
    • A-E assessment of patient including adequate IV access and rapid fluid resuscitation
    • Direct pressure if bleeding site if visible
    • Urgent senior surgical review

Surgical Site Infection

  1. Typically seen around post-operative day 7
  2. Pyrexia, surgical site – erythema, warmth, tenderness and fluctuance
  3. Management
    • Only cellulitis – consider removing clips/sutures at site, culture swabs and antibiotics
    • If abscess is present/ suspected – wound must be opened and drained
    • If unclear – use US +/- CT to diagnose

Post-surgery Ileus

Small bowel ileus

  1. 1-2 days post-op
  2. Paralytic ileus is the term for small bowel ‘obstruction’ due to lack of peristalsis 
  3. Aetiology – post surgery, electrolyte disturbance (hypokalaemia or metabolic acidosis), trauma, ischaemia, peritonitis, dehydration 
  4. Check electrolytes (Na, K, Mg, PO4) – correct any electrolyte disturbances
  5. AXR
  6. Wide bore NG tube insertion, IV fluids, NBM

Large bowel ileus

  1. 3-5 days post-op
  2. @ pseudo-obstruction @ Ogilvie syndrome 
  3. Progressive and painless dilation of colon, functional obstruction of the large bowel secondary to ileus or electrolyte disturbance in severely ill patients 
  4. Will usually resolve with supportive care  
  5. If not responding, colonic decompression should be undertaken/ neostigmine

Anastomotic leak

  1. Often due to tissue ischaemia or tension on the anastomosis, rectal and oesophageal surgeries have highest rate of leaks  
  2. Presentation
    • Abdominal pain and fever, usually 5-7 days post-op
    • Pyrexia, tachycardia, AF
    • Signs of peritonism
    • Prolonged periods of ileus
  3. Investigations
    • Bloods – FBC, U&E, LFT, clotting screen, G&S, venous blood gas
    • CT scan with contrast
  4. Management
    • Early resuscitation – IV Fluids + IV antibiotics
    • NBM
    • Definitive management depends on extent of leak, contamination and patients physiological status
    • May require enteral feeding if prolonged periods of fasting

Wound dehiscence

  1. Typically seen around post-operative day 5 after open laparotomy
  2. Wound looks intact but large amounts of pink, serous fluid soaks the dressing – this is peritoneal fluid
  3. Reoperation is needed to avoid peritonitis and evisceration (skin opens up and abdominal contents rush out)