What to assess at a 2-week post-operative visit for a left lower quadrant (LLQ) mass excision?

Assessment at 2-Week Post-Operative Visit for Left Lower Quadrant Mass Excision

At a 2-week post-operative visit following a left lower quadrant mass excision, assessment should focus on wound healing, signs of infection, pain management, and early detection of complications to optimize patient outcomes and prevent morbidity.

Key Components of Assessment

Wound Evaluation

• Inspect the surgical site for:
  • Signs of proper healing (approximated edges, decreasing erythema)
  • Signs of infection (excessive redness, warmth, purulent drainage)
  • Dehiscence or wound separation
  • Seroma or hematoma formation
  • Appropriate suture/staple integrity if still in place
  • Need for suture/staple removal if appropriate timing

Pain Assessment

• Evaluate pain levels using a standardized scale
• Assess pain characteristics (location, quality, radiation)
• Review pain medication usage and effectiveness
• Identify any concerning pain patterns that might indicate complications 1
• Document any changes in pain pattern since discharge

Systemic Signs of Complications

• Check vital signs, particularly for fever
• Assess for systemic signs of infection (malaise, chills)
• Screen for signs of deep vein thrombosis (calf pain, swelling)
• Evaluate for signs of pulmonary complications (shortness of breath)

Functional Recovery

• Assess return to activities of daily living
• Evaluate mobility and any movement restrictions
• Document any limitations in function compared to pre-operative status
• Determine readiness to return to work or normal activities 2

Gastrointestinal Function

• Assess for normal bowel function return
• Document any changes in bowel habits
• Screen for constipation (common post-operative issue)
• Evaluate for any signs of bowel obstruction (abdominal distention, nausea, vomiting)

Imaging Considerations

Routine imaging is not typically indicated at a 2-week post-operative visit unless there are concerning findings on clinical examination. However, if complications are suspected:

• CT abdomen/pelvis with IV contrast is the gold standard imaging modality (rated 8/9 for appropriateness) if post-operative complications are suspected 3, 1
• Ultrasound may be considered if there is concern for fluid collection or abscess, particularly to avoid radiation exposure 1

Laboratory Assessment

Consider laboratory tests if infection or other complications are suspected:

• Complete blood count to assess for leukocytosis
• C-reactive protein or ESR to evaluate for ongoing inflammation
• Other tests as indicated by specific clinical concerns

Common Complications to Screen For

• Surgical site infection (occurs in approximately 5% of clean-contaminated cases)
• Seroma formation
• Hematoma
• Wound dehiscence
• Recurrence of pathology (if mass was neoplastic)
• Adhesion formation (may present as early bowel obstruction symptoms)

Documentation and Follow-up Planning

• Document wound appearance with photographs if appropriate
• Establish appropriate follow-up timeline based on findings and pathology results
• Review pathology results if available
• Determine need for additional treatments based on final pathology
• Provide patient education regarding warning signs that should prompt urgent evaluation

Special Considerations

• If the excised mass was potentially malignant, discuss pathology results and need for additional treatment
• If the surgery involved bowel resection, pay particular attention to bowel function
• Consider the need for additional follow-up imaging based on the nature of the excised mass 3, 1

Remember that approximately 8-9% of surgical patients may experience major post-operative complications within the first year 4, making thorough assessment at the 2-week visit critical for early intervention.