Infections of the urinary tract.

Embryology of anorectal malformations.

Reoperations in anorectal malformations.

Background
Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery.

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Intracavity lavage and wound irrigation for prevention of surgical site infection.

Midterm follow-up study of high-type imperforate anus after laparoscopically assisted anorectoplasty.

Background/Purpose: Anorectal malformations are one of the most common congenital defects. This study was undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types of defects, their sex distribution and the spectrum of anomalies associated with ARM. The effect of presence of an associated defect on mortality and morbidity was also studied. Materials and Methods: One hundred consecutive children attending the pediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever indicated. Management was as per the standard protocol. The data was recorded and analyzed. Results: Out of the 100 patients, 51 were males and 49 females. One out of every 6.62 admission was for ARM. Twenty percent of the female babies had high, 76% intermediate and 4% had low anomalies, whereas 80.39% males had high, 3.92% intermediate and 15.6% showed low malformations. Ten percent of the patients had pouch colon. Associated anomalies were seen in 33 patients - 20 males and 13 females; 19 in high, 10 in intermediate, 1 in low group and 3 children with cloacal malformations. Associated defects seen were urogenital (17%), cardiovascular (7%), gastrointestinal (9%), genital (5%) and limb defects (7%). There were 8 deaths, and complications were seen in 13 patients. Ten patients had two or more defects associated with ARM. Conclusions: Anorectal malformations occurred equally in males and females. Females had intermediate defects more frequently, rectovestibular fistula being the commonest. Males were more likely to have high lesions; anorectal agenesis without fistula was the commonest defect. The most common associated defects seen were vesicoureteric reflux and esophageal atresia. Complications were seen more commonly in males with high lesions. There was a significant association between presence of an associated defect and mortality and morbidity.

Anorectal malformations in children

In state-run hospitals in India, pre-existing malnutrition and anaemia with late presentation, septicaemia and gross peritoneal contamination lead to a very high wound infection rate despite the use of systemic antibiotics. We studied the wound infection rate of subcutaneous infiltration of metronidazole (group B) versus irrigation with saline (group A) in patients undergoing exploratory laprotomy for perforation peritonitis with pyoperitoneum. The study included 30 patients in group A and 30 in group B. In group A 66.6% of the patients developed wound infection, whereas in group B 26.6% only developed wound infection. This difference is found to be statistically significant at a level of P < 0.01. There was no local complication attributable to infiltration of metronidazole in group B. Thus, we concluded that local infiltration of metronidazole at the incision is a safe and effective measure to control wound infection in cases of perforation peritonitis with pyoperitoneum.

Wound infection after metronidazole infiltration

A secondary vesical calculus develops in the presence of outflow obstruction, infection or in the presence of a foreign body. A 19-year-old Hindu male, manual laborer by occupation and resident of an urban slum, presented to the surgery OPD with one year old complaints of suprapubic pain, frequency of passing urine, low grade hematuria, fever and passage of foul smelling urine with pus for the past 6 months. History revealed retention of urine one year before. The patient went to seek the advice of a local practitioner, who inserted a hollow tube transurethrally. Urine culture revealed E.coli in significant levels sensitive to Cefotaxime and Norfloxacin. A plain X-ray KUB showed a mass suggestive of a single bladder calculus. On detailed examination of the stone, a secondary calculus appeared developed over a mass of coiled tube. The stone was removed via suprapubic cystostomy. INTRODUCTION A secondary vesical calculus develops in the presence of outflow obstruction, infection or in the presence of a foreign body. Presenting features include suprapubic pain, dysuria, frequency of micturition and hematuria. Diagnosis is by a plain X-ray KUB or an ultrasonography, which shows a radiolucent shadow changing position with patient movement. Treatment is by endourological procedures or a suprapubic cystotomy if the stone is large (size greater than 3 cm).1 CASE REPORT A 19-year-old Hindu male, manual labor by occupation and resident of an urban slum, presented to the surgery OPD with complaints of Suprapubic pain for the past 1 year Frequency of passing urine for the past 1 year Hematuria for the past 1 year Fever, low grade, off and on for the past 1 year Passage of foul smelling urine with pus for the past 6 months On taking a detailed history, it was recorded that the patient had an episode of severe suprapubic pain, dysuria and a sudden onset of retention of urine 1 year before. The patient went to seek the advice of a local practitioner, who inserted a hollow tube transurethrally by which urine was drained. The patient was also given oral medication. The patient did not pay heed to the hollow tube and did not have any other episode of retention. He did not note what happened to the tube after that. There is no history suggestive of tuberculosis or diabetes mellitus. Since then the patient had the above symptoms repeatedly and was treated by a local practitioner. A general physical examination did not reveal any abnormality except pallor. On per abdomen examination there was suprapubic tenderness. Urine culture revealed E.coli in significant levels sensitive to Cefotaxime and Norfloxacin. Hemoglobin was 8.6gm% and TLC was 12500/cu mm. A plain X-ray KUB revealed a mass suggestive of a single bladder calculus. Blood sugar, blood urea and serum creatinine were normal. Preanesthetic investigations were done and the stone was removed via suprapubic cystotomy. Intravenous Cefotaxime was given to the patient for 5 days. Postoperatively, the patient was also given Norfloxacin for 5 days. The stitches were removed on day 8 and the patient was discharged. When the patient reported for follow-up 3 months later, he was asymptomatic Migrated Urethral Catheter In The Urinary Bladder Forming A Stone And Presenting As Recurrent Urinary Tract Infections 2 of 3 and urine culture was sterile. On detailed examination, the stone appeared as a secondary calculus developing over a mass of coiled tube shown in figure 1. Figure 1 Figure 1: Photograph of specimen removed from the bladder DISCUSSION Recurrent urinary tract infection is uncommon in males and usually occurs due to an abnormality of the urinary tract, stricture or foreign body1. In our case, a hollow tube was inserted which migrated into the bladder, with the patient unaware. A foreign body in the bladder has been documented as a cause of recurrent urinary tract infection2. A detailed history and a high index of suspicion help to arrive at the diagnosis. Plain X-ray KUB and ultrasonography confirm diagnosis. Antibiotic therapy should be guided by culture and sensitivity. References 1. Anthony J Schaffer. Infections of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED et al., eds., Campbell's Urology. USA:Saunders, 1998: 590-591 2. Rafique M. Case report: An unusual intravesical foreign body: Cause of urinary tract infections. Int Urol Nephrol. 2002; 34(2): 205-6 Migrated Urethral Catheter In The Urinary Bladder Forming A Stone And Presenting As Recurrent Urinary Tract Infections 3 of 3 Author Information Pranshu Bhargava, MBBS, M.S Dept. of Surgery, Lady Hardinge Medical College Nidhi Mehrotra Dept. of Surgery, Lady Hardinge Medical College

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Pranshu Bhargava

Papers

Anorectal malformations in children

Wound infection after metronidazole infiltration

Migrated Urethral Catheter In The Urinary Bladder Forming A Stone And Presenting As Recurrent Urinary Tract Infections