Leena Mendiratta

Recurrent high fistula-in-ano: Think of tuberculosis!

A 41-year-old male presented with purulent discharge and pain in the perianal region. There was no history of fever or weight loss. The patient gave a history of being operated 14 times earlier for the same complaints. Perioperative discharge showed acid-fast bacilli on Ziehl-Neelsen (ZN) stain. No pulmonary focus of tuberculosis (TB) was found. The patient was started on antitubercular treatment and has not reported any pain or discharge from the perianal region for the last 1 year. A high index of suspicion of TB should be kept in mind in perianal lesions, especially recurrent lesions, even when no primary focus is found. Surgery and medical treatment combined may be needed in such cases.

Surgical Site Infection

ABSTRACT The incidence of surgical site infections (SSI) depends upon the patient risk-factors, surgical procedure, and practices observed by the operating team. This review aims at examining existing guidelines upon prevention of SSI. Various recommendations pertaining to pre-operative, operative and postoperative phase were evaluated. Implementation of measures like meticulous surgical scrubbing, and surgical site preparation, appropriate antimicrobial prophylaxis (right antimicrobial, dose, timing, and duration), right operative environment, observing strict antisepsis, and glucose control have majorly contributed towards reducing infections. Surveillance strategies towards SSI are essential as they help in guiding towards appropriate implementation of various measures.