Laparoskopik kolesistektomiden sonra nontüberküloz mikobakteriyel giriş yeri enfeksiyonu

Mikobakteriler için giriş yeri mikobakteri enfeksiyonu alışılmadık bir komplikasyondur. Bu makale laparoskopik kolesistektomiden sonra giriş yeri mikobakteri enfeksiyonunu bildirmeyi ve bu alışılmadık komplikasyonun tanı ve tedavisini açıklamayı amaçlamıştır. Bu vaka serisi Al-Azhar Universite Hastanesi, Kahire, Mısır’da laparoskopik kolesistektomiden sonra giriş yerinde iyileşmemiş sinünü olan 7 olguyu içerir. Tanıyı doğrulamak için iki yöntem kullanılmıştır: giriş yerinden alınmış sürüntü kültrünün bakteriyolojik tanısı ve giriş yeri iyileşmemiş sünüsü tekrar açıldıktan sonra alınan örneğin histopatolojik incelemesi. Bakteryolojik and histopatolojik testler 4 olguda mikobakteri enfeksiyonunu ortaya koydu. Sinogramda ve sinüsün cerrahi eksizyonu sırasında özel karakteristik bir görüntü vardı. Tüm vakalar titiz cerrahi ve antimikobakteriyel tedaviden sonra iyileşti. Mikobakteri enfeksiyonu giriş yerinde yara iyileşmesinde gecikmenin nedenlerinden biri olabilir ve tedavi büyük oranda titiz cerrahi eksizyona bağlıdır.

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. 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.

PDF

___

1. Sung WR, Sonya S, Myung-Shup S, Yoon-Sung P, Woo JL, Sue-Nie P, Young KP and Seongman K. Spread of Nontuberculous Mycobacteria from 1993 to 2006 in Koreans. Journal of Clinical Laboratory Analysis 2008; 22: 415-420.
2. Katoch VM. Infections due to non-tuberculous mycobacteria (NTM). Indian J Med Res 2004; 120: 290-304.
3. Ramesh H, Prakash K, Lekha V, Jacob G, Venogobal A and Venogobal B. Port-site tuberculosis after laparoscopy; Report of eight cases. Surg Endosc 2003; 17: 930-932.
4. Jagdish N, Sameer R and Omprakash R. Port-site tuberculosis: a rare complication following laparoscopic cholecystectomy. Scand J Infect Dis 2002; 34 (12):928-929.
5. Vess RW, Anderson RL, Carr JH, Bond WW and Favero MS. The colonization of solid PVC surface and the acquisition of resistance to germicides by water micro-organisms. J Appl Bacteriol Feb 1993; 74 (2): 215-221.
6. Sattar SA, Kibbee RJ, Tetro JA and Rook TA. Experimental evaluation of an automated endoscope reprocessor with in situ generation of peracetic acid for disinfection of semicritical devices. Infect Control Hosp Epidemiol 2006; 27 (11): 1193-1199.
7. Wang GO, Zhang CW, Liu HC and Chen ZB. Comparison of susceptibilities of M. tuberculosis H37Ra and M. chelonei subsp. abscessus to disinfectants. Biomed Environ Sci 2005; 18 (2): 124-127.
8. Griffiths PA, Babb JR, Bradley CR and Fraise AP. Glutaraldehyde-resistant Mycobacterium chelonae from endoscope washer disinfectors. J Appl Microbiol 1997; 82(4):519-526.
9. Lindenboom JA, Kuijper EJ, Bruijnesteijn Van Coppenraet ES, Lindenboom R and Prins JM. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis 2007; 44(8): 1057-64.