Mr. Rao (name changed) 38yr old was admitted last month to Nanavati Super Speciality Hospital. He came with the complaints of a continuously discharging sinus in the left groin region. The hole was continuously discharging pus since last 7 months. Upon taking relevant history from the patient, we got the information that he was operated for Left groin (Inguinal) hernia surgery in Mangalore in the month of May 2016. This surgery was done laparoscopically.
However, instead of quick recovery, Mr. Rao had pain in the region of surgery not relieved by medications. Later by the end of seven months of surgery, there was pus discharge from the wound. It was confirmed there was infection in the Mesh(synthetic net cloth)which had been put inside for repair of the hernia. So, the surgeon (from Mangalore) later took the patient for second surgery to remove the mesh laparoscopically. On doing so, he found tubercles in the interior of the abdominal cavity (peritoneum). Based on this a diagnosis of abdominal tuberculosis was given. The patient was put on anti- tubercular treatment for a period of 6 months, after which it was stopped due to intolerance by patient.
However, a sinus started draining in the groin from the left side. An MRI scan was done which revealed a sinus tract from the site of surgery to the left groin. However, since MRI did not reveal the relation of the track with intestines, a CT sinogram was done. This was done by insertion of a fine tube from the external opening of the sinus tract to the abscess cavity. This showed a complete tract. Patient was taken for surgery on the basis of this CT report & exploration & excision of sinus tract with debridement of the wound was planned. However, for demarcation prior to surgery when a fine catheter attached to a syringe was passed through the tract, I could aspirate the pus.
Dr.ParthivSanghvi -Consultant General & Laparoscopic Surgery, NSSH dissected the entire tract, which went behind the anterior abdominal wall musculature. And lo, what do I behold THE PREVIOUS MESH WHICH WAS SUPPOSED TO HAVE BEEN REMOVED WAS FOUND INSIDE. I removed the mesh & the pus was sent for further examination. The wound was thoroughly cleaned & washed & closed. Another astonishing finding was that the pus had grown ATYPICAL MYCOBACTERIA. This is the type of bacteria which is usually seen in patients where the instruments have not been sterilized properly. From this we gather, that laparoscopic surgery should be done in a hospital setup where proper facilities for instrument sterilization exist. The patient is recuperating well.