Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy.

Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. A young man presented with epigastric pain and bilous vomiting followed by haematemesis 15 years after vagotomy & gastrojejunostomy for chronic duodenal ulcer. At presentation the patient was in shock and an emergency laparotomy was done after resuscitation. At laparotomy a retrograde type II JGI was found and managed by resection of the affected segment and partial gastrectomy and jejuno - jejunostomy with closure of the duodenal stump. Postoperative recovery was uneventful. Retrograde JGI is a rare condition and only less than 200 cases have been reported since its first report. Clinical picture of acute intestinal obstruction with suspicion about the condition in patients having a past history of gastrojejunostomy makes the elusive diagnosis definite and demands early surgery to reduce the grave consequences of the disease.

Pattern of aerobic bacteria with their drug susceptibility of surgical inpatients.

The pattern of aerobic bacteria with their antibiotic susceptibility isolated from infected patients in one of the surgical units at Mymensingh Medical College Hospital during the period from September to November' 2000 were reported in the present study. Out of 74 clinical samples, 52 were wound swabs, 18 were pus and 4 were urine. Bacterial growth was yielded in 43 samples and the distribution of isolates was as follows: Pseudomonas spp 16, Esch.coli 13, Staphylococcus aureus 08, Klebsiella spp. 03 and others 03. Majority (61.5 %) of culture positive results were found in wound swabs. Antibiotic susceptibility pattern showed considerable variation within Gram negative bacterial isolates. All the Esch.coli and Klebsiella isolates were resistant to amoxicillin. Ceftriaxone (65.6% and 100% respectively) and ciprofloxacin (71.4% and 100%) still appeared to be highly sensitive for both species. Over 93% strains of Pseudomonas were sensitive to Ceftazidime and aztreonam. Whereas, over 43% of same strains were resistant to ciprofloxacin. Over 87% strains of Staph.aureus were resistant to penicillin but sensitive to erythromycin. Whereas, 100% of those strains were sensitive to cloxacillin. Over 50% of all isolates were sensitive to gentamicin but resistant to cefalexin and cotrimoxazole. It was suggested to be careful regarding selection of antibiotic regime in surgical cases to minimize incoming higher magnitude of drug resistance among bacteria in near future.

Pattern of bacteria and their antimicrobial susceptibility isolated from inanimate objects and hospital personnel.

Different inanimate samples collected from surgery wards and general operation theatre (GOT) as well as animate samples from surgery personnel were subjected to aerobic culture with the aim of identifying source of infections in surgical cases. The pattern of aerobic bacteria with antibiotic susceptibility isolated from those samples were reported in the present study. Out of 91 such samples, 53 and 26 were from different locations in general wards and OT respectively and 12 were comprising of hand swabs, throat swabs and nasal swabs from surgery personnel. Pathogenic bacteria were isolated from 34 samples having Pseudomonas spp. (18/34) in the top of the list followed by Esch. coli (14). Among the Esch.coli isolates resistance to cotrimoxazole, amoxicillin and doxycycline were 78.7%, 71.4% and 57.1% respectively, whereas sensitivity to aztreonam, ceftazidime, gentamicin and ciprofloxacin were 100%, 85.8%, 78.7% and 71.4% respectively. Ceftriaxone yielded intermediate sensitive results in 21.4% strains. Isolates of Pseudomonas spp. also showed very high sensitive results to aztreonam, ceftazidime and ceftriaxone (94.7%, 94.7% and 84.2% respectively). Ciprofloxacin and gentamicin were sensitive in 68.4% and 57.9% respectively. Susceptibility pattern showed well correlation with clinical response in infected cases.