CASE: Unusual case^-www.drkeyurbhatt.in*

74 yrs male + DM + HTN + IHD + COPD

with 1 month history of on and off fever...initially treated as Malaria...later as Typhoid..
cont. diarrhoea...c/o distension and abdominal discomfort for 2 days...
rising bilirubin..., constipation..No..nausea/vomiting...

USG : s/o gross peritonitis CBD 7mm, GB partially distended....rest all WNL... TLC: 21,000. Pt Disoriented with electrolyte imbalance...

Suspected Enteric perforation...... and found to have PERFORATED GB with gross (4 liters) biliary peritonitis...No Gall Stones...CBD normal...

? typhoid induced GB perforation...? lower end block / impacted small stone / stricture

Surgery (lavage, Cholecystectomy, drainage) done in Epidural anesthesia in view of multiple risks...and post op patient is doing well...

later develop bile leak...in drain...Suspected Cystic duct stump blown out...USG: repeated : s/o lower end Small 7 mm impected stone...dilated CBD and IHBRD....

Pt underwent ERC & removal of ampulary impected stone and stenting.....
doing well now...

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Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

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