HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome

Mahamudu Ayamba Ali; Israel Hagbevor; Raymond Saa-Eru Maalman; Yaw Otchere Donkor; Florence Dedey; Emmanuel Abedi

doi:10.1016/j.ijscr.2021.106726

HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome

Int J Surg Case Rep. 2022 Jan:90:106726. doi: 10.1016/j.ijscr.2021.106726. Epub 2021 Dec 30.

Authors

Mahamudu Ayamba Ali¹, Israel Hagbevor², Raymond Saa-Eru Maalman³, Yaw Otchere Donkor³, Florence Dedey⁴, Emmanuel Abedi²

Affiliations

¹ Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana. Electronic address: aayamba@uhas.edu.gh.
² Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana.
³ Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana.
⁴ Department of Surgery, University of Ghana Medical School, Korle-Bu - Accra, Ghana.

Abstract

Introduction and importance: Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection.

Case presentation: A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years.

Clinical discussion: The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection.

Conclusion: Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection.

Keywords: Complicated hernia; Complicated hernia wound; Nylon darn repair; Retroviral infection; Surgical site infection.