Learning Things the Hard Way

Curing an infection due to lack of sterilisation
of medical tools during surgery

THE CASE

A 38-year old patient was admitted in Nanavati Super Speciality Hospital with complaints of sinus discharging continuously in his left groin region for the past seven months. In May 2016, he was operated Laparoscopically for left groin (inguinal) hernia in Mangalore. However, instead of speedy recovery, the patient had pain in the region of surgery which was not relieved by medications. Even after seven months of surgery, pus was still being discharged from the wound. The surgeon took the patient for a second Laparoscopic surgery to remove the mesh, as there was infection in the mesh which had been put inside for hernia repair. During the procedure, the doctor found tubercles in the interior of the abdominal cavity. The patient was then put on anti-tubercular treatment for a period of six months, after which it was stopped due to intolerance by the patient. Not long after, pus started draining again from the infected groin area, suggesting the necessity of further treatment.

THE PROCEDURE

An MRI scan was done which revealed a sinus tract from the site of the surgery to the left groin. Since MRI did not reveal the relation of the track with intestines, a CT Sinogram was also done by inserting a fine tube from the external opening of the sinus tract to the abscess cavity. The patient was taken for surgery on the basis of this CT report; exploration and excision of sinus tract with debridement of the wound was planned. However, for demarcation prior to surgery, a fine catheter attached to a syringe was passed through the tract and pus was aspirated. The entire tract was then dissected which went behind the anterior abdominal wall musculature. It was observed that the previous mesh which was supposed to have been removed was still inside. The mesh was removed and the pus was sent for further examination. The wound was thoroughly cleaned, washed and closed. The pus was later found with atypical mycobacteria. This is the type of bacteria which is usually seen in patients where the instruments used have not been sterilised properly.

THE RESULT

After the procedure, the patient recuperated well. As the subsequent days were uneventful, without any signs of the infection coming back, the doctors allowed the patient to get discharged to be followed-up later.

DISCUSSION

It is highly recommended that Laparoscopic surgery should always be done in a hospital set-up where proper facilities for instrument sterilisation exist.

Dr. Parthiv Sanghvi

Dr. Parthiv Sanghvi
General & Laparoscopic
Surgeon, Gastroenterology
Nanavati Super Speciality
Hospital, Mumbai






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