Fifty cases of acute appendicitis were examined at operation for the presence of free organisms on or around the appendix in situ, and for bacterial contamination of the wounds after removal of the appendix. Fifty‐four per cent had free organisms around the appendix, 40 per cent of the wounds probably became contaminated, and 18 per cent became clinically infected.
The operative technique was modified in 50 cases to minimize the chance of contaminating the wounds. There were 2 infections (4 per cent). In another series in which the usual operative technique was used the wounds were irrigated with tetracycline solution; there was 1 infection in 50 cases, an incidence of 2 per cent. In a similar trial the use of a mixture of powdered antibiotics in 50 cases did not influence the wound infection rate which remained at 18 per cent.
The use of tetracycline solution and care in avoiding contamination of the wound are recommended.
SUMMARYStones are overlooked in the bile-ducts during operations for gall-stones sufficiently often to pose a continuing problem. The choledochoscope, first described 50 years ago, has recently been developed to a degree which makes it valuable in locating common-duct stones, besides permitting observation of changes in the ducts which are not otherwise demonstrable.At 37 duct explorations, among a total of 135 gallstone operations, endoscopy was found valuable in clarifying equivocal pre-exploratory cholangiograms, or on occasion taking their place, and in detecting stones not removed using the usual methods of detection. It is suggested that endoscopy is quicker and more readily repeatable than post-lithotomy cholangiography, is unaffected by bubbles entering the duct system, and avoids exposure of staff and patient to X-rays. However, it should be used in conjunction with pre-exploratory cholangiography.
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