A 47-year-old woman presented to the ED on November 6 with abdominal pain. The patient had undergone a Roux-en-Y gastric bypass surgery on October 20. She had developed worsening abdominal pain, and went to see a nurse practitioner at an outpatient clinic. She was given Rocephin and Phenergan, and then referred to the ED.

On arrival to the ED, the patient was seen by a physician. The T-sheet is shown below. The copies entered in the trial for this case are of particularly poor quality, therefore a summary of the information is shown below. The chief complaint is left abdominal wall abscess/drainage. Onset was today. Context: bypass on 10/20, now with incisional infection and drainage at L upper abdomen. A set of vitals revealed a temperature of 100.3 F, BP 141/74, HR 114, respirations 28/min, 100% O2 sat. The patient was noted to be in moderate distress. She had ecchymosis on her right side with a drain, the incision had purulent material and there was surrounding cellulitis. A CT with contrast was ordered to rule out abscess. An IV was started, she was given 1L NS bolus, several doses of morphine and Zofran.

Chemistry:

Glucose 98 mg/dL BUN 7 mg/dL Creatinine 0.6 mg/dL Sodium 134 mmol/L (L) Potassium 3.2 mmol/L (L) Chloride 96 mmol/L (L) CO2 22 mmol/L Calcium 9.1 mg/dL Anion Gap 19 mmol/L (H) GFR estimated 114 mL/min

CBC:

WBC 15.9 K/uL(H) RBC 4.16 mil/dL (L) HGB 11.7 g/dL (L) HCT 35.1% (L) MCV 84.4 fl MCH 28.2 pg MCHC 33.4 g/dL Platelets 494 K/uL (H) Differential NEUT 70.9% (H) LYMP 20.6% (L) MONO 6.1% EOS 0.7% BASO 1.7% ABS NEUT 11.3% (H) ABS LYMPH 3.3% ABS MONO 1.0% (H) ABS EOS 0.1% ABS BASO 0.1% (H)













A CT scan was ordered. The results are below.

Given this information, what would be the appropriate next steps? Can this patient be discharged?