Background There is ambiguity about the use of antibiotic prophylaxis in inguinal mesh hernioplasty. We have tried to assess the efficacy of antibiotic prophylaxis in this procedure.

Aims: Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed. Methods: The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed. Results: Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI. Conclusions: Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients. The role of the spleen in the body's immune response to a variety of infections and the serious consequences of its removal have been increasingly recognised over the past 40-50 years.1 The asplenic condition results in an increased risk of life threatening sepsis as a result of encapsulated and Gram negative organisms, and carries considerable mortality. The overall incidence of septicaemia is low, but death rates from overwhelming post splenectomy infection (OPSI) have been reported to be 600 times greater than that for the general population, with an ominous estimated lifetime risk for OPSI of approximately 5%.2 With increasing awareness of the risk associated with the asplenic state, splenic salvage surgery is now gaining popularity.3 4 However, there are many clinical indications that warrant a total splenectomy, such as extensive splenic trauma or haematological disorders, resulting in a large population of asplenic patients.''Patient education and counselling at the time of splenectomy is just as important as appropriate vaccination and antibiotic prophylactic measures'' Vaccination strategies, which started with the use of the pneumococcal vaccine, have been modified since their inception in the 1970s to circumvent the emergence of antibiotic resistant strains and the recognition of other pathogens that cause...

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Non-traumatic perforation of small intestine is a common cause of peritonitis in developing countries requiring early surgical intervention. Various etiological factors have been proposed as the cause of small bowel perforation. It is difficult to diagnose cause of non-traumatic perforation of small bowel preoperatively, so histopathology is a very important diagnostic tool. In this study consisting 40 patients, nontraumatic perforations were more common in males (72.5%) than females (27.5%) with maximum number of non-traumatic perforations (42.5%) occurring in the age group of 21-40 years and the minimum number (12.5%) occurring in the age group of ≤ 20years and >60 years, each. The most common etiology was nonspecific ileitis followed by tuberculosis, neoplasms and then, enteric fever.