Surgical infections
-
Surgical infections · Feb 2014
Case ReportsThoracic gallstones: a delayed complication of laparoscopic cholecystectomy.
Thoracic complications resulting from gallstone spillage during laparoscopic cholecystectomy are rare and may occur years after the index surgery. We present the case of a chronic lung abscess resulting from trans-diaphragmatic migration of gallstones spilled and "lost" during a laparoscopic cholecystectomy. ⋯ Thoracic complications from "lost" gallstones following laparoscopic cholecystectomy include empyema, hemoptysis, and cholelithoptysis. These rare complications sometimes require surgery but not all presentations of thoracic gallstones mandate operative intervention. Because of these potential complications of "lost" gallstones, reasonable efforts should be made to retrieve gallstones spilled during cholecystectomy. Persistent pulmonary symptoms following laparoscopic cholecystectomy mandate further radiologic examination and a review of the patient's operative report for "lost" gallstones.
-
Surgical infections · Feb 2014
Is extended antibiotic prophylaxis necessary after penetrating trauma to the thoracolumbar spine with concomitant intraperitoneal injuries?
Prolonged courses of broad-spectrum antibiotics are often cited as standard care for the prevention of infectious complications in thoracolumbar or sacral (TLS) fractures following penetrating abdominal trauma. Perforation of a hollow viscus in addition to a TLS fracture is believed to be associated with a high incidence of spine infection. Because over use of antibiotics is associated with an increasing prevalence of multi-drug-resistant organisms, this study seeks to define the actual risk of infection of the spine and need for antibiotics in patients with TLS fractures and intraperitoneal injuries following penetrating trauma. ⋯ In this study, 92% of patients received antibiotics for 48 h or less with no increased incidence of spine infections. Bacterial colonization of the vertebrae was not higher in patients with penetrating gastrointestinal injury. There is insufficient evidence to support the use of prolonged antibiotic prophylaxis to prevent spine infection in patients with penetrating abdominal trauma and TLS fracture.