Abdominal wall sinus tact and infection.

The chronic fistulous tract will not heal by itself and will require further management. It can get complicated if ignored.

Visit a general surgeon and plan to get a CECT abdomen and pelvis to look for the extent of the tract and plan for an elective surgery for the excision of the tract.

Consult a doctor immediately incase of fever, chills or severe pain.

It looks like a foreign body(?Suture) induced granuloma with a sinus tract which has got infected. Treating infection is just a temporary measure. But for permanent cure it requires surgical managament.

Consult a general surgeon as it requires surgical excision of the sinus tract.

The whole collection need to be drained and Tract need to be excised , for better delineation of Tracts MR fistulogram need to be done .start sensitive antibiotic as per culture report ,

MRI Fistulogram , Excision of tracts

Keep the area clean and apply some antiseptic cream ,till the management is done , Get Diabetic profile done

The ultrasound suggests a chronic sinus tract with a thick-walled collection at the previous C-section scar extending deep across the rectus muscle up to the prevesical space, with branching (ramification) and multiple external openings. This is unlikely to heal with antibiotics alone. The pus culture has grown Staphylococcus haemolyticus, which is sensitive to Vancomycin, Teicoplanin, Daptomycin, Tigecycline and Tetracycline, while resistant to several commonly used antibiotics including oxacillin, linezolid, fluoroquinolones, cotrimoxazole and clindamycin. The most likely diagnosis is a chronic post-operative sinus, often secondary to retained infected suture/foreign body or chronic infected granulation tissue. Recommended management: * Contrast-enhanced CT sinogram or MRI sinogram (if feasible) to delineate the complete sinus tract and rule out communication with deeper structures. * Treat active infection with culture-directed antibiotics. * Definitive treatment is complete surgical exploration with excision of the entire sinus tract and removal of any retained foreign material/non-absorbable sutures, along with drainage/debridement of infected tissue. Antibiotics alone usually result in recurrence. * Histopathological examination of the excised tract should be sent, and atypical infections (e.g., tuberculosis) should be considered if clinically indicated or if healing is delayed.

Consult an experienced General Surgeon for definitive surgical management rather than repeated dressing or prolonged antibiotics.

Hi Usg shows sinus with collection Get cect abdomen pelvis so see correct extension of sinus tract ( have to rule out any intraperitoneal connection ) Meet general surgeon plan for sinus tract excision They will dye through opening excise the tract ,suction and debridement of collection to be done

Get cect abdomen and pelvis

Start antibiotics Tab. Niftas-100 mg 1-0-1 Tab.Pan-40 mg 1-0-0