Evaluation of gastrografin effect in treatment of adhesive small bowel obstruction after failure of conservative treatment

Besides the diagnostic role of oral gastrografin [hyperosmolar contrast media] to differentiate partial from complete small bowel obstruction [SBO] and its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. Patients with symptomsand signs suggestive of adhesive small bowel obstruction [SBO] were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 hours had conservative treatment continued. Patients who showed no improvement in the initial 48 hours were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 hours were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 hours were considered to have complete obstruction and laparotomy was performed. Eighty patients with episodes of adhesive obstruction were included. Five patients were operated on soon after admission due to fear of strangulation. Forty five patients showed improvement in the initial 48 hours and conservative treatment was continued, two patients had subsequent operations because of persistent obstruction. Thirty episodes of obstruction showed no improvement within 48 hours and gastrografin was administered. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe, allows a shorter hospital stay and reduces the need for surgical intervention

Port-site non-tuberculous mycobacterial infection after laparoscopic cholecystectomy: a case series study

Port-site infection by mycobacterial organism is an unusual complication. This article aims to report the occurrence of port-site mycobacterial infection after laparoscopic cholecystectomy and to describe the diagnostic and therapeutic tools of this unusual complication. This case series study included 7 cases presented by port-site unhealed sinuses after laparoscopic cholecystectomy in Al-Azhar University hospital, Cairo, Egypt. Two methods were used to confirm the diagnosis; the bacteriological diagnosis by culture of pus collected from the port-site and histopathological examination of specimens after resection of port-site unhealed sinuses. Bacteriological and histopathological examinations showed the presence of mycobacterial infection in 4 cases [57,1%]. There was a special characteristic picture on sinogram and during surgical excision of the sinuses. All cases cured by meticulous surgery followed by anti-mycobacterial medications. Mycobacterial infection may be one of the causes of port-site delayed wound healing and the treatment should mainly depend on good meticulous surgical excision