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Case 132: Blue-Green colouration on the dressing

The dressing was taken down from a patients laparotomy wound. It was day 7 post operation.

1. What are the possible causes for this discoloration on the dressing?

The possibility of an enteric fistula should always be considered, especially if the dietitian has put blue food colouring in the enteric feed to try and demonstrate such a fistula.
However, the most likely cause for this is a pseudomonas aeruginosa colonisation/infection of the wound.

2. What other features on examination would point to the diagnosis?

A strong pungent odour. Some say it is a fruity odour, however it is more like the smell of sweaty socks dipped in ammonia.