Port site tuberculosis after laparoscopic cholecystectomy: A rare complication with review of literature

Abstract

Laparoscopic procedures are routinely performed in most surgical centers today. Surgical site infections at port sites following laparoscopy are not uncommon. However, port site tuberculosis (TB) is a rare complication following a laparoscopic procedure. The possible causes of its development include improper sterilization of instruments, use of tap water containing resistant atypical mycobacteria to clean these instruments before immersion into glutaraldehyde solution; and seeding at the port site due to gall bladder TB. We report here a case of a young female who underwent laparoscopic cholecystectomy outside our hospital and then developed a discharging sinus at the epigastric port site. Three attempts of debridement and wound closure had already been done before and every time there was a recurrence. Sinus tract was excised after getting the sinogram, and the histopathology showed features consistent with TB. The patient was put on anti-tubercular therapy, and she had no recurrence after 3 months of follow-up.

Port site tuberculosis a rare post operation entity: A case report

“…One of the limitations of this report stems from the patients’ lack of knowledge regarding his previous procedure. Therefore, we can only speculate that the source of infection was poorly sterilized instruments, which is supported by previous reports [ [7] , [8] , [9] ].…”

“…Our case was managed in a sequential way where the infection was treated first and then incision and drainage were performed. Previous reports show a similar pattern which includes drainage and excision apart from a minor change, we used empirical antibiotics in the patient initially [ [6] , [7] , [8] ].After the biopsy results, previous studies also show how anti-tubercular therapy was the best treatment with promising results and these drugs were given in our case as well [ [6] , [7] , [8] , [9] ]. A multi-disciplinary effort is required to tackle such cases.…”

“…It is suggested that when suspecting such a similar case in a patient following negative results in the initial lab investigations including blood culture, pus C/s and the usual, the sample should be sent to histopathology for prompt diagnosis. This suggestion stems from the fact that the previous reports also show how the diagnosis was confirmed on biopsy after initial negative results, as shown in Table 1 [ [6] , [7] , [8] , [9] ].…”

Port Site Infections Following Laparoscopic Cholecystectomy

“…The advanced sterilization systems such as STERRAD, which uses gas plasma technology to kill bacteria at low temperature or ethylene oxide gas may be used to sterilize laparoscopic instruments . 2,8,11,13,16,42,43 …”

“…Considering all these most likely transmissions would be via the laparoscopic instruments as it shown in other studies. 2,8,9,42,43 It is widely agreed that 2% gluteraldehyde achieves high level of disinfection and not sterilization. Several publications have highlighted failure to sterilize the instruments if soaked for 20 minutes in 2% alkaline gluteraldehyde solution.…”