72-year-old with abdominal wall abscess

Abstract

A 72-year-old female presented to the Emergency Department (ED) reporting one week of increasing abdominal pain, distension, and discoloration over her mid abdomen. She had an abdominal ventral hernia repair with mesh 6 months prior. The incision had healed well after surgery but began swelling and draining a small amount of greenish fluid the week prior. She went to her primary care physician and was placed on antibiotics for concerns of cellulitis; however she did not fill the prescription. Associated symptoms included fatigue, nausea, and shortness of breath. She denied fevers or vomiting. Pertinent past medical history included coronary artery disease, hypertension, hyperlipidemia, methacillin resistant staphalococcus aureus (MRSA) skin abscesses, and an abdominal wall reconstruction with bilateral component separations and implantation of mesh 6 months ago. Physical examination revealed an afebrile, obese female in no distress with a tender 6×8 cm area of erythema with central greenish discoloration over her mid abdomen (Image 1, black arrow). An abdominal/pelvic computed tomography (CT) scan with intravenous (IV) contrast was obtained (Image 2, red arrow) revealing a large anterior abdominal wall abscess centered predominantly in the musculature with superficial extension into the subcutaneous fat, all above the mesh. The patient was started on IV vancomycin and piperacillin/tazobactam due to her history of MRSA and admitted to general surgery. She was taken to the operating room for open drainage of the abscess,