ABSTRACT
BACKGROUND: It is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure (PC). The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis. METHODS: A total of 70 patients with perforated appendicitis were included. They were randomized to have their surgical incisions (skin and subcutaneous tissue) either PC or left open with Betadine-soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure. A wound was considered infected if pus discharged from the incision site. The main outcome measures were the incidence of wound infection and the length of hospital stay (LOS). RESULTS: In the entire series, wound infection developed after incision closure in 21.4% of the patients. The PC group had a higher incidence of wound infection (38.9% vs. 2.9%, p<0.001) and longer LOS (8.4 days vs. 6.3 days, p=0.038). CONCLUSION: Delayed primary closure is the optimal management strategy for perforated appendicitis wounds. It significantly reduces the wound infection rate and length of stay.
Subject(s)
Appendicitis/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy , Child , Child, Preschool , Female , Humans , Incidence , Length of Stay , Male , Middle Aged , Prospective Studies , Surgical Wound Infection/epidemiologyABSTRACT
The development of tuberculosis-related bowel obstruction or pseudo-obstruction during anti-tuberculosis therapy is rarely reported in immunocompetent patients. A 44-year-old male, who had neither HIV infection nor diabetes, was hospitalized because of pulmonary tuberculosis in November 2006. Three months after starting anti-tuberculosis therapy, he was admitted for suspected mechanical bowel obstruction. An emergency exploratory laparotomy showed distended bowel loops, and multiple skip lesions from the terminal ileum to the ascending colon. PCR analyses showed Mycobacterium tuberculosis. The therapy regimen was unchanged after the operation; the patient gradually improved over the course of a month and was discharged without further symptoms thereafter.
Subject(s)
Antitubercular Agents/therapeutic use , Intestinal Obstruction/microbiology , Intestinal Pseudo-Obstruction/microbiology , Mycobacterium tuberculosis , Tuberculosis/complications , Adult , Colon/microbiology , Humans , Ileum/microbiology , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/drug therapy , Intestinal Pseudo-Obstruction/diagnostic imaging , Intestinal Pseudo-Obstruction/drug therapy , Male , Mycobacterium tuberculosis/isolation & purification , Sputum/microbiology , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis/drug therapyABSTRACT
OBJECTIVES: To determine the spectrum of microorganisms, clinical features, and risk factors of necrotizing fasciitis in southeast Taiwan. METHODS: We retrospectively studied patients diagnosed with necrotizing fasciitis and fully treated in our hospital for the period January 1995 to December 2006. RESULTS: The mean age of the patients was 58.2+/-14.2 years. The affected anatomical sites were primarily peripheral (91 patients, 85.8%). Sixty patients (56.6%) had a type 1 infection, 17 patients (16.0%) had type 2, and eight patients (7.5%) had type 3. Diabetes mellitus was the most common comorbidity. A single pathogen was identified as the infectious agent in 64 patients (60.4%), multiple pathogens were identified in 21 patients (19.8%), and no organism was identified in 21 patients (19.8%). Streptococcus pyogenes was the most common pathogen. The average hospital stay was 28.0+/-23.1 days. Patients received a mean of 2.3+/-1.2 debridements, and five patients (4.7%) eventually underwent an amputation. The overall mortality was 17.0%. Predictors of mortality included advanced age, class C liver cirrhosis, ascites, higher serum creatinine, and lower hemoglobin and platelet levels. CONCLUSIONS: Monobacterial infections are more common in our patients. Accurate early diagnosis and extensive surgical debridement are essential for a favorable outcome.
Subject(s)
Fasciitis, Necrotizing , Gram-Negative Bacterial Infections , Gram-Positive Bacterial Infections , Adult , Aged , Comorbidity , Diabetes Mellitus/epidemiology , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/mortality , Fasciitis, Necrotizing/physiopathology , Fasciitis, Necrotizing/surgery , Female , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/mortality , Gram-Negative Bacterial Infections/physiopathology , Gram-Negative Bacterial Infections/surgery , Gram-Positive Bacteria/classification , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/mortality , Gram-Positive Bacterial Infections/physiopathology , Gram-Positive Bacterial Infections/surgery , Humans , Male , Middle Aged , Prognosis , Streptococcus pyogenes/isolation & purification , Taiwan/epidemiologyABSTRACT
BACKGROUND/PURPOSE: Open wound management has long been the most common practice after appendectomy for perforated appendicitis. Primary closure, however, has recently been advocated to reduce cost and morbidity. The aim of this study was to compare the results of open wound management and primary wound closure in adult patients (age, > or =15 years) with perforated appendicitis. METHODS: Hospital records of 390 patients (age, > or =15 years) who underwent appendectomy between January 2002 and December 2004 were reviewed to identify surgical wound infection (SWI) and pathologic diagnosis. Perforated appendicitis was the indication for appendectomy in 65 of these patients. The incision wounds in these 65 patients were closed primarily in 41 and left open at the end of the operation in 24. The duration of symptoms, white blood cell count, operative time, incidence of SWI, length of stay (LOS) and readmission rate were compared between patients with these two different methods of wound management. RESULTS: Patients whose wounds were closed primarily had a higher incidence of SWI (43.9% vs. 4.2%, p < 0.001) and longer LOS (10 days vs. 7.9 days, p = 0.044). The readmission rate was also higher for patients whose wounds were closed primarily; however, this difference was not significant. CONCLUSION: Open wound management may be preferable to primary wound closure for perforated appendicitis in adults because of a lower incidence of SWI and a shorter LOS. Randomized clinical trials, however, are needed to establish these findings.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Appendectomy , Appendicitis/surgery , Drainage/methods , Surgical Wound Infection/therapy , Wound Healing , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Surgical Wound Infection/pathology , Treatment OutcomeABSTRACT
The incidence of gastrointestinal stromal tumor (GIST) among neurofibromatosis type 1 (NF-1) patients is approximately 3.9-25%, and this relationship is generally considered to be non-coincidental. We report a patient with NF-1 who underwent laparotomy 3 times due to recurrent intra-abdominal tumor rupture with internal bleeding in the space of 13 years. The pathologic diagnoses were schwannoma, malignant peripheral nerve sheath tumor and GIST. Because of the similar histologic features of these tumors, we considered them to be of the same nature. Immunohistochemical staining can help in the differential diagnosis. We suggest that NF-1 patients with gastrointestinal symptoms receive further survey to rule out GISTs.
