Robotic-Assisted Hysterectomy Results in Postoperative Infection

This case involves a fifty-eight-year-old female patient who presented to her OBGYN complaining of post-menopausal bleeding. The patient underwent a failed dilation and curettage by a previous physician who told her that she had a thickened endometrial stripe. The patient underwent a da Vinci robotic-assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for the treatment of her symptoms. Subsequently, the patient developed a severe iatrogenic infection and proximate non-healing wound from the surgical site. At the time of the patient’s first postoperative follow-up visit, the surgical wound was malodorous and purulent, which was indicative of abscess formation. The patient was sent away after this visit without any blood work ordered, or any antibiotics prescribed. As a result, the patient required wound vac treatment for approximately five weeks and nearly six months of intricate wound dressing treatment to finally close the primary wound.

Question(s) For Expert Witness

1. What is the standard of care in treating an abdominal abscess once identified?

Expert Witness Response E-000051

Antibiotic therapy involves the administration of parenteral empirical antibiotics. It should be initiated before abscess drainage and concluded when all systemic signs of sepsis have resolved. Because abscess fluid usually contains a mixture of aerobic and anaerobic organisms, initial empiric therapy must be directed against both types of microbes. This may be accomplished with antibiotic combination therapy or with broad-spectrum, single-agent therapy. Specific therapy is then guided by the results of cultures retrieved from the abscess.