Surgical Site Infection
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Surgical Site Infection
Preventing Surgical Site Infection (2024)
Perioperative- A 42-year-old man with a body mass index (BMI) of 34 has stricturing Crohn’s and will need to undergo an ileocecectomy. He smokes a half pack of cigarettes per day. He has previously failed azathioprine and 6-mercaptopurine (6-MP), and he is currently on infliximab and a prednisone taper. What modifiable risk factor would be the most helpful to mitigate to decrease his chances of postoperative infectious complications?
- A 45-year-old man is diagnosed with sigmoid colon cancer on screening colonoscopy. Staging workup shows no evidence of metastatic disease. Which of the following combinations, in addition to standard intravenous antibiotic prophylaxis, is recommended to decrease surgical site infection after segmental colectomy?
- A 75-year-old man with hypertension, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and diabetes is about to undergo an emergent open sigmoid resection for a large bowel obstruction. Which of the following measures has been shown to decrease postoperative surgical site infection (SSI)?
Perioperative- A 56-year-old woman with type 2 diabetes requires an elective sigmoid resection for diverticulitis. Her daily blood glucose is well controlled with metformin and glipizide. To reduce surgical site infection after colectomy, her intraoperative blood glucose level should be:
- A 45-year-old man recently underwent a low anterior resection with coloanal anastomosis for a tumor located 3 cm from the anal verge. In this patient, which preventive measure would be most effective in reducing postoperative septic complication following an anastomotic leak?
General Postoperative Complications- Use of Bowel Preparation in Elective Colon and Rectal Surgery (2019)
- Miscellaneous
Local Excision- Sexually Transmitted Infections of the Colon and Rectum
- Pilonidal Disease and Hidradenitis Suppurativa
- Proctectomy for Rectal Cancer
- Intestinal Stomas
- Preoperative Evaluation in Colorectal Patients
- Abdominal Wall Reconstruction and Parastomal Hernia Repair
- Quality
- Colonic Diverticular Disease
- Anorectal Disease
- A 43-year-old woman underwent a ligation of intersphincteric fistula tract (LIFT) 7 weeks ago to close her posterior transsphincteric anal fistula. She has had persistent discharge from her intersphincteric wound. On clinical examination, she was found to have a persistent internal opening and the external opening has healed. What would be the most appropriate procedure to perform next to resolve her drainage?
- A 52-year-old woman presents with a distal recurrent rectovaginal fistula after 2 failed endorectal advancement flap repairs. She had normal findings on colonoscopy and endorectal ultrasonography confirmed a rectovaginal fistula in the very distal rectum with an intact sphincter complex and seton in place. What is the best next surgical treatment?
- An obese 45-year-old man presents for follow-up after undergoing a bedside incision and drainage of a recurrent left ischiorectal abscess. On examination, you observe a draining left ischiorectal surgical site as well as a right ischiorectal skin punctum that has been draining for several months. What is the most likely underlying cause?
- Enhanced Recovery After Colon and Rectal Surgery from ASCRS and SAGES (2023)
- Clostridium difficile Infection
- Infectious Colitis
- Fecal Incontinence: Evaluation and Treatment
- Malignancy
- An otherwise healthy 50-year-old patient reports rectal fullness and pain while sitting. On examination, the rectal mucosa is smooth; however, you can palpate a large firm mass that appears extraluminal and extends to the tip of your examining finger. Cross-sectional imaging reveals a large heterogeneous presacral mass that measures 7 cm x 10 cm. The best next step in management is
- A 56-year-old obese man with locally advanced distal rectal cancer is treated with total neoadjuvant chemoradiation therapy. His is a 45-pack-per-year smoker. Restaging reveals no sign of metastasis. Magnetic resonance imaging (MRI) rectal protocol reveals partial clinical response and flexible sigmoidsociopy that shows a 3-cm tumor involving the sphincteric complex. What is the best surgical approach in his care?
- Presacral Tumors
- Preoperative Preparation
- Benign Disease
- A 56-year-old man with a remote history of uncomplicated sigmoid diverticulitis presents with pneumaturia, fecaluria, and frequent urinary tract infections. Colonoscopy showed sigmoid diverticulosis. Computed tomography (CT) of the abdomen and pelvis showed air in the bladder. Cystoscopy showed 1.5 cm defect in the bladder. The best next step in the management of this patient is
- A 29-year-old patient with prior history of a total colectomy and end ileostomy for fulminant ulcerative colitis presents with peristomal skin irritation and difficulty with leakage around the stoma. Painful, ulcerated purple nodules with violaceous borders are seen around the stoma site, as shown in the image below. Biopsy of the lesion shows neutrophil infiltration and perivascular lymphocytic infiltration and no infection. What is the best next step in management for this patient?
- A 65-year-old man who underwent a recent colostomy for fecal incontinence presents to your office with a symptomatic parastomal hernia, despite multiple appliance changes. What is the best step for definitive treatment?
- Crohn’s Disease: Surgical Management
- Optimizing Outcomes with Enhanced Recovery
- Anorectal Disease
- A 20-year-old male patient with a history of a previous incision and drainage of pilonidal abscess presents to the office with gluteal cleft pain and intermittent bleeding and drainage from several midline pits with no improvement with conservative management. He is a college student with a summer internship while at home and would like to address the problem before he goes back to school. What is the best recommendation for this patient at this time?
- A 27-year-old male patient presents for evaluation of new anal lesion 2 weeks after anal intercourse with a new male partner. The lesion is at the anal verge, round, ulcerated, and non-tender (see figure below). The optimal therapy for this patient is
- Parastomal and Perineal Hernias
Finding the Left Ureter in Diverticulitis or Obesity- Surgical Management of Crohn's Disease (2020)
- Rectal mucosal flaps
- Anal Cancer
- Minimally invasive stapling in the deep pelvis
- Malignancy
- ASCRS Webinars
- Complete mesocolic excision
- Management of Pilonidal Disease (2019)
- Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
- Pelvic Floor
- Pediatric Colorectal Disorders
- Treatment of Left-Sided Colonic Diverticulitis (2020)
- Management of Clostridioides difficile Infection (2021)
- Ulcerative Colitis: Surgical Management