Nokea
On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to 40oC. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foul-smelling, of dark-gray color. What is the most likely diagnosis?
Correct Answer: A
Rationale: The correct answer is A: Anaerobic clostridial wound infection. The symptoms and signs described (bursting pain, weakness, drowsiness, fever, swollen skin, gas crepitation, foul-smelling dark-gray discharge) are classic for gas gangrene, caused by Clostridium perfringens. Gas gangrene is an anaerobic infection that thrives in devitalized tissue, such as postoperative wounds. The gas crepitation is due to gas production by the bacteria. Abscess (B) typically presents with localized swelling and fluctuance, not gas crepitation. Postoperative wound infection (C) may present with redness, warmth, and increased wound discharge but not the specific features mentioned. Erysipelas (D) is a superficial bacterial skin infection, typically caused by Streptococcus pyogenes, presenting with well-defined raised borders and redness.