Differential Diagnosis for 64-year-old Female with Hernia Repair and 16-day Post-op Fever
- Single most likely diagnosis:
- Surgical site infection: This is the most common cause of post-operative fever, especially in the context of a recent hernia repair. The timing of 16 days post-op is consistent with a surgical site infection, which can occur due to bacterial contamination during the procedure.
- Other Likely diagnoses:
- Urinary tract infection (UTI): UTIs are common in post-operative patients, especially in older adults, and can cause fever. The use of urinary catheters during or after surgery increases the risk of UTI.
- Pneumonia: Post-operative pneumonia is a significant concern, especially in older patients or those with underlying respiratory conditions. The stress of surgery, immobilization, and potential aspiration can contribute to the development of pneumonia.
- Deep vein thrombosis (DVT) or pulmonary embolism (PE): Although less common, DVT or PE can cause post-operative fever. Immobilization during and after surgery increases the risk of venous thromboembolism.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sepsis: Sepsis is a life-threatening condition that can arise from any infection, including surgical site infections, UTIs, or pneumonia. Early recognition and treatment are crucial to prevent high mortality.
- Intra-abdominal abscess: An intra-abdominal abscess can occur as a complication of hernia repair, especially if there was bowel injury during the procedure. This condition requires prompt diagnosis and treatment to prevent severe consequences.
- Necrotizing fasciitis: Although rare, necrotizing fasciitis is a deadly condition that can occur after surgery. It is characterized by rapid progression of infection and tissue necrosis, requiring immediate surgical intervention.
- Rare diagnoses:
- Adhesive bowel obstruction: This is a rare but possible cause of post-operative fever, especially if there was bowel manipulation during the hernia repair. Adhesive bowel obstruction can lead to bowel ischemia and necrosis if not promptly treated.
- Hernia mesh infection: Infection of the hernia mesh is a rare but serious complication of hernia repair. It can cause chronic infection and may require removal of the mesh.