The FP diagnosed cellulitis with a probable abscess over the neck. He explained that the pus over the neck needed to be drained and the grandmother (the child’s sole caretaker) gave her consent for the procedure. The area of maximal fluctuance was identified by palpation and the FP injected 1% lidocaine with epinephrine to numb the area. He then proceeded with the incision and drainage of the abscess, being careful to stay away from vital structures in the neck.
A significant amount of pus was drained and the finger of a sterile glove was cut off to place in the drainage site to allow for continued drainage. The patient was given ceftriaxone intravenously and the child remained in the community health center overnight with her grandmother and the nursing staff on duty.
The following day, the child was doing much better and her appetite started to return. Two days later, the child was afebrile and was sent home with her grandmother. The FP and the medical student mission team continued to make house calls daily and administer antibiotics until the child's infection was fully resolved.
The importance of incision and drainage cannot be overstated in this case. While cutting over the neck of a non-anesthetized child has its risks, allowing a neck abscess to remain surgically untreated can be life-threatening.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Cellulitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:693-697.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
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