Anaerobic Profile of Intra-abdominal Infections – A 23-Year Retrospective Study

Obligate anaerobes, which are part of normal intestinal flora are now gaining pathogenic potential by becoming more virulent and causing moderate to severe abdominal infections. Moreover, there is delay in initiation of appropriate antimicrobial therapy. The study aimed to describe and analyse 23 years data on anaerobic intra – abdominal infections in regards to the distribution and antimicrobial susceptibility patterns of the obligate anaerobes which were isolated from various intra – abdominal infections. The demographic and microbiological data was retrieved from the microbiology departmental registers. Total number of cases/specimen were 1124. Bacteroides fragilis group (238) (56%) and Peptostreptococcus sp (109) (25%) amounted to the majority of the isolates. Rare anaerobes like Clostridium sporogenes, Propionibacterium sp, Clostridium bifermentans and Fusobacterium varium were also isolated. Majority of mixed anaerobic infections were contributed by Bacteroides fragilis group and Peptostreptococcus sp (99) out of 102 mixed anaerobic infections). Chronic alcoholism was the most common predisposing condition (p value <0.05). Among the antimicrobials which were used by the clinicians for treating the infection, only Metronidazole was tested for its susceptibility pattern. One isolate was resistant to metronidazole (Diameter of inhibition zone was 6 mm). As they are fastidious they usually go unnoticed. Hence, this descriptive study intends to bring light on the large number of various obligate anaerobes and the potential diseases that they can cause and also the need for their antibiotic susceptibility testing to look for antimicrobial resistance among the isolates

Lymphadenovarix in the axilla – an unusual presentation of filariasis

Clinical manifestations of lymphatic filariasis depend on the area of lymphatic involvement and the duration of infection. A 21 year old man, resident in a filariasis endemic region, presented with multiple matted lymph nodes with cystic areas forming a large mass in his left axilla. An ultrasound scan of the axilla using a 7.5 MHz transducer revealed grossly dilated lymphatics but no filarial dance sign. Fine needle (21 G) aspiration cytology (FNAC) from the dilated lymphatics and solid areas in the lymph node mass revealed multiple microfilariae in a background of reactive lymphoid cells. Peripheral blood smears revealed microfilaremia with significant eosinophilia. Diagnosis of left axillary Bancroftian lymphadenovarix was made. On the administration of oral diethylcarbamazine, the diameter of the lymphatic vessels in the lymphadenovarix reduced considerably in size and microfilaremia disappeared. We report this case because axillary lymphadenovarix is a rare presentation of filariasis. This case is also unique since microfilariae were demonstrated in the fluid aspirated from the dilated lymphatics of the lymphadenovarix in the absence of live adult worms

Postoperative pain relief following abdominal operations: A prospective randomised study of comparison of patient controlled analgesia with conventional parenteral opioids

BACKGROUND: Parenteral opioids are traditionally used for pain management following abdominal operations. Patient Controlled Analgesia (PCA) is replacing the conventional method for postoperative pain relief nowadays. AIMS: To find out the effectiveness of PCA in postoperative pain relief following abdominal operations. SETTINGS AND DESIGN: This prospective randomised study was conducted in the Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India. MATERIALS AND METHODS: Sixty-two consecutive patients undergoing abdominal operations were randomly divided into PCA group (n=32) who received intravenous PCA morphine and IM group (n=30) who received conventional intramuscular morphine in the postoperative period. Morphine consumption, pain relief, detailed pulmonary function tests and side-effects of morphine were assessed. STATISTICAL ANALYSIS: This was performed by "Epi Info 2000 version 6". Chi-square and Students 't' tests were used to relate the variables. RESULTS: The total morphine consumption of the PCA group was significantly lesser than IM group (mean 30.84 mg versus 37.36 mg P-0.015) and it was less at different intervals in the postoperative period. The PCA group had better pain relief when compared to the IM group (mean pain score 3.42 versus 4.97 P&lt;0.001). Pulmonary function parameters did not show a significant difference at different intervals in the postoperative period except for Peak Expiratory Flow Rate. None of the patients had major morphine-related complications. CONCLUSIONS: Intravenous PCA provides better pain relief with less morphine consumption as compared to the conventional IM method. Recovery of postoperative pulmonary functions showed no significant difference in the two groups apart from Peak Expiratory Flow Rate, which showed significant early recovery in the PCA group

Spontaneous cecal perforation secondary to acute fulminant gastroenteritis: report of a rare case

Acute gastroenteritis and food poisoning are the two common diagnoses considered when two or more family members present with vomiting, diarrhea, and abdominal pain. Acute fulminant gastroenteritis is usually seen in immunocompromised patients and is associated with significant morbidity and mortality. We report a 15-year-old boy who presented with acute onset abdominal pain, vomiting, and diarrhea, along with three other family members. He developed abdominal distension and signs of hollow viscus perforation after 3 days; by that time he had developed  respiratory distress requiring ventilatory assistance. During laparotomy, a 1-cm cecal perforation with feculent peritoneal contamination was noted. Limited ileocolic resection and ileostomy was performed and ileostomy closure was carried out at 6 weeks. This case is being reported to highlight the unusual presentation of fulminant gastroenteritis, leading to spontaneous cecal perforation.Keywords: acute gastroenteritis, fulminant gastroenteritis, spontaneous cecal perforatio

Enterocutaneous fistula due to mesh fixation in the repair of lateral incisional hernia: a case report

Enterocutaneous fistula following mesh repair of incisional hernia is usually due to mesh erosion of the underlying viscus and presents late. We describe an early enterocutaneous fistula due to an unusual but a potential mode of bowel injury during mesh fixation. This case is reported to emphasize the need for greater attention to the technique of mesh fixation. We suggest laparoscopic guidance to prevent this serious complication in lateral Incisional hernias with ill defined edges of the defect

Biliary cystadenocarcinoma of the gall bladder: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Nonspecific Cecal Ulcer: An Obsolete Jargon

Non specific cecal ulcer (NSCU) is a rare entity described by Cruveilhier in 1832. NSCU has no specific presenting features and it can mimic a host of conditions like appendicitis, diverticulosis and colonic carcinoma. Earlier, this terminology was used to depict those ulcers where it was not possible to make the exact diagnosis. There are only a few cases where a specific preoperative diagnosis was made. The number of NSCUs being reported recently is less. This is due to the advent of newer diagnostic techniques to identify the etiology of these ulcers. Hence the term NSCU is no longer employed in current literature because a specific diagnosis is attained in most ulcers. Therefore the term NSCU is no longer valid and its use should be largely restricted to those cases where a specific diagnosis is not possible even after exhausting the currently available investigative techniques. This article provides an overview of this outdated term and outlines how to proceed when NSCU is encountered in clinical practice. [J Interdiscipl Histopathol 2013; 1(2.000): 85-88

Postoperative pain relief following abdominal operations: A prospective randomised study of comparison of patient controlled analgesia with conventional parenteral opioids

BACKGROUND: Parenteral opioids are traditionally used for pain management following abdominal operations. Patient Controlled Analgesia (PCA) is replacing the conventional method for postoperative pain relief nowadays. AIMS: To find out the effectiveness of PCA in postoperative pain relief following abdominal operations. SETTINGS AND DESIGN: This prospective randomised study was conducted in the Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India. MATERIALS AND METHODS: Sixty-two consecutive patients undergoing abdominal operations were randomly divided into PCA group (n=32) who received intravenous PCA morphine and IM group (n=30) who received conventional intramuscular morphine in the postoperative period. Morphine consumption, pain relief, detailed pulmonary function tests and side-effects of morphine were assessed. STATISTICAL ANALYSIS: This was performed by "Epi Info 2000 version 6". Chi-square and Students 't' tests were used to relate the variables. RESULTS: The total morphine consumption of the PCA group was significantly lesser than IM group (mean 30.84 mg versus 37.36 mg P-0.015) and it was less at different intervals in the postoperative period. The PCA group had better pain relief when compared to the IM group (mean pain score 3.42 versus 4.97 P<0.001). Pulmonary function parameters did not show a significant difference at different intervals in the postoperative period except for Peak Expiratory Flow Rate. None of the patients had major morphine-related complications. CONCLUSIONS: Intravenous PCA provides better pain relief with less morphine consumption as compared to the conventional IM method. Recovery of postoperative pulmonary functions showed no significant difference in the two groups apart from Peak Expiratory Flow Rate, which showed significant early recovery in the PCA group