Clinical Significance of Bacteriuria in Patients with Orthotopic Sigmoid Neobladder after Radical Cystectomy

Objectives: To evaluate the incidence and clinical significance of bacteriuria in patients who underwent sigmoid neobladder substitution after radical cystectomy. Patients and Methods: The study included 149 patients with invasive bladder carcinoma who underwent radical cystectomy and orthotopic sigmoid bladder substitution. Diagnosis of bacteriuria was made by freshly collected midstream urine culture at 3; 6 and 12 months postoperatively. Positive urinary culture was defined as 100 000 colony forming units (CFU)/ml. The data collected were evaluated in correlation to the clinical status of the patients. Results: Overall 466 urine samples from 149 patients were cultured during the follow-up period. Out of these 149 patients; 18 were lost to follow-up and 11 patients developed new stone formation in the neobladder with an incidence of bacteriuria of 91. These 29 patients were excluded from the study. Among the remaining 120 patients; positive urine culture with significant growth of uropathogens was seen in 64; 47and 33at 3; 6 and 12 months; respectively. Two thirds of patients with positive urine cultures were asymptomatic. The commonest uropathogen encountered was E Coli (72) followed by Klebsiella (12). Conclusion: Sigmoid neobladder substitution is associated with a high incidence of bacteriuria. Despite; the spontaneous clearance of bacteriuria over time without antimicrobial manipulation; antimicrobial therapy was needed in some patients; particularly those with a large post-void residual (PVR) urine volume; persistent urosepsis and stone formation in the neobladder

Ileosigmoid Knotting : A Report of Two Cases

Background: Ileosigmoid knotting (ISK) is a rare cause of acute intestinal obstruction with high morbidity and mortality. The diagnosis is rarely made preoperatively because of its infrequency and the variations in presentation.Aim: To report two cases managed by the author; which will hopefully increase awareness of this condition.Case Reports: The first was a 51-year-old man who presented with a sudden onset of colicky lower abdominal pain; which later became generalized. His pulse rate was 100 beats/minute while his blood pressure was 80/60 mmHg.There was mild abdominal distension with absent bowel sounds. The second was a 50-year-old man with a sudden onset of generalized colicky abdominal pain; abdominal distension and vomiting. His pulse rate was 120 beats/minute and the blood pressure 80/50 mmHg. His bowel sounds were markedly reduced. They were resuscitated accordingly. In both patients; exploratory laparotomy revealed a copious amount of sero-sanguinous fluid in the peritoneal cavity with ileosigmoid knotting; and extensive gangrene involving the distal ileum and the sigmoid colon. In the first patient; the caecum was involved in the knot and therefore also gangrenous. Each of them had a sigmoid colectomy with a right hemicocetomy. The first patient died of adult respiratory distress syndrome while the other had an uneventful recovery. In the patient who died; surgery was done on the third day of onset of symptoms.Conclusion: A high index of suspicion; aggressive resuscitation; and prompt surgical intervention are indispensable for a successful outcome

Sigmoid volvulus: an alternative operation?

Presents the activities of Queen Elizabeth Central Hospital in treating sigmoid volvulus