38 yrs male with stab in abdomen before one month...with peritonitis ...explored and found to have Transverse colon and gastric perf. ...closed primarily....improved gradually.....
developed distension and persistant fever....G/C detoriating gradually.....CECT was done....found to have RHC collection ? biliary?
next day Per Cut Drain was kept....draining bile...ERC tried but papilla was not located...
later Referred for biliary fistula to me...
As the fistula was controlled with drain around 200ml of bile/day...and pt was clinically improving and taking oral diet..passing stool....kept conservatively....
Unfortunately pt took DAMA....re admitted after 5days with distension of abdomen and drain out put of >1400ml/day.....? high out put fecal fistula ......and pt started detoriating fast with sepsis and shock...
CECT was repeated ... Revalled multiple intra abdominal collection and peri pancreatic necrosis...
Taken up for surgery.... Intra abdominal collections drained....bowel was healthy though out..
Drain tract explored from rt flank...and RETROPERITONEAL NECROSECTOMY was done thorough lavage and Laparoscopic (retro peritoneal) drainage of dirty material was done...
Remained on venti for 2.5 days ....now taking oral diet ..passing stool...POD 6 (today) out of ICU. ..having biliary fistula in Rt flank drain which is retro peritoneal and controlled one...TLC normal...sepsis controlled shifted to ward...now one drain out and patient having a low biliary fistula..<30 ml /day only Rt drain... fit for discharge (24.1.11)....pt discharged.....on 27.1.11..(POD 21)
ADVANTAGE OF RETRO PERITONEAL NECROSECTOMY....
developed distension and persistant fever....G/C detoriating gradually.....CECT was done....found to have RHC collection ? biliary?
next day Per Cut Drain was kept....draining bile...ERC tried but papilla was not located...
later Referred for biliary fistula to me...
As the fistula was controlled with drain around 200ml of bile/day...and pt was clinically improving and taking oral diet..passing stool....kept conservatively....
Unfortunately pt took DAMA....re admitted after 5days with distension of abdomen and drain out put of >1400ml/day.....? high out put fecal fistula ......and pt started detoriating fast with sepsis and shock...
CECT was repeated ... Revalled multiple intra abdominal collection and peri pancreatic necrosis...
Taken up for surgery.... Intra abdominal collections drained....bowel was healthy though out..
Drain tract explored from rt flank...and RETROPERITONEAL NECROSECTOMY was done thorough lavage and Laparoscopic (retro peritoneal) drainage of dirty material was done...
Remained on venti for 2.5 days ....now taking oral diet ..passing stool...POD 6 (today) out of ICU. ..having biliary fistula in Rt flank drain which is retro peritoneal and controlled one...TLC normal...sepsis controlled shifted to ward...now one drain out and patient having a low biliary fistula..<30 ml /day only Rt drain... fit for discharge (24.1.11)....pt discharged.....on 27.1.11..(POD 21)
 |
| healing necrosectomy site in Rt flank |
ADVANTAGE OF RETRO PERITONEAL NECROSECTOMY....
Dr. Keyur Bhatt - Best
Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon
Dr. Keyur Bhatt - Best
Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr Keyur
Bhatt- Best GI Surgeon
