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Wednesday, September 5, 2012

CASE: COROSSIVE INGESTION , GASTRIC NECROSIS, WITH SITUS INVERTUS IN 3 YR OLD CHILD

with Respected DR. YATINBHAI THAKAR (M.S.,M.S., Pediatric surgeon)

3 YR OLD MALE (SITUS INVERTUS) child presented in emergency with distension, hemetemesis after corossive ingestion

1.  lavage and multiple drains were kept in abdomen (as the patient's G/C was very poor) to sustain a major surgery
2. after 6 days he improved and was even extubated on day 3 of index surgery...taken up for definative phase one surgery
   
Total gastrectomy (as 80 % of stomach of necrosed)  and duodenal stump closure, along with lower esophageal end closure..and feeding jejunostomy

3. after successful recovery from 2nd surgery was discharged on FJ Feeds...gained 4 kg weight in 3.5 months...was re-evaluated for esophageal status..and found to have a single short segment small stricture in upper esophagus which was negotiable with endoscope...and was taken up for definitive surgery

ROUX EN Y , J POUCH DOUBLE STAPLE ESOPHAGO JEJUNOSTOMMY and FJ

recovered well started tolerating FJ From day 3 and dye study from oral route did not show any anastomosis  leak..but unfortunately had a kink at the NEW FJ site..and was having recurrent bilious vomiting...

4. was taken up once again and kink was taken care of  along with removal of FJ...Patient was happily discharged on day 4 with normal diet...without any complication..child is play full..taking oral diet....