For my surgery rotation, I had the opportunity to present my patient cases to Professor Rachwalski. I chose to do 8 SOAP notes instead of 3 H&Ps. I felt it was more appropriate to do SOAP notes because the nature of the rotation. Out of the 8 cases, the most interesting case was the one about the 31 year-old female with PMH of hidradenitis suppurative s/p bilateral axillary skin resection complaining of left gluteal and right groin pain/swelling for 1 week. The patient reported swelling that started as a small boil, gradually worsened, and was now draining. Pain was aggravated with sitting and movement. She denied fever, chills, nausea, vomiting, diarrhea, urinary complaints, hematuria, shortness of breath, or chest pain.

At this point I had not come up with differentials as the patient had a known history of hidradenitis. 

On exam, patient appeared uncomfortable, unable to lay on her back due to pain, but was not in acute distress. She had a 7 x 3 cm right groin open wound, no drainage, or erythema and 6 x 6 cm left gluteal open wound with surrounding swelling, induration with drainage, tender to palpation, no erythema. 

Labs notable for WBC 13, PLT 595, H/H 10.4/32.5 and CRP 51. CT scan showed 2 left perianal abscess collections connected by fistulous tracts with third irregular shaped fluid collection posterior to coccyx that may possibly be another abscess.

Based on physical exam findings, labs and imaging, it was thought that the patient would benefit from an exam under anesthesia as we were unable to obtain a good exam, and an incision and drainage would be too painful to do bedside.

After receiving feedback from my site evaluator, it was discussed that I should think about other possible things that could be causing the patient to develop abscesses, such as diabetes. The patient did not admit to having a history of diabetes, but the site evaluator noted that it probably would’ve been a good idea to check her glucose levels and evaluate her for diabetes. Another suggestion the professor gave was to make my SOAP notes more concise by leaving out sections such as, PMH, surgical hx, ROS, etc. The last recommendation he made was to qualify the drainage noted on exam. For instance, was the drainage purulent, serosanguinous, etc.