Sunday, July 31, 2011

CASE: Gangrenous cholecystitis

24 yr male with pain and jaundice
found to have ? CBD Stone. ERC and cleared & stented
post procedure pancreatitis ...kept conservatively ...improved..but unfortunately developed gangrenous cholecystis with perforation.

SURGERY: OPEN chelecystectomy



post op biliary fistula sattleing down conservatively...

CASE: PERSISTENT NON HEALING FECAL FISTULA

Middle aged man with intestinal obstruction
operated more than 3 months ago and resection anastomosis done for ischemic stricture..
developed controlled fecal fistula
kept conservatively...but was non healing and developing episodes of SAIO.... And out put was around 400~500 ml / day
CECT was done and taken up for surgery
SURGERY:  Segment baring fistula was resected with new ileo ileal anastomosis (side to side) and adhesilysis.




pt was discharged with normal diet on POD 6.

CASES: 1.PERFORATED PAYOCELE 2. PERFORATED GB WITH CIRRHOSIS OF LIVER

CASE 1.OLD age women with perforated payocele of GB. Status ERC and stone clearance and stented.
was advised cholecystectomy 8 months back refuted....

ultimately landed with perforation of payocele with perforation and
SURGERY: Open cholecystectomy


CASE 2: Old age women with GB STONE and cholecystitis...kept conservatively in view of Cirrhosis of liver..
symptoms increased and was taken up for LAP cholecystectomy few months back...but considering the liver condition and intrahepatic situation of GB surgery was abandoned after placement of camera.

remained asymptomatic for another few months
now presented with sever pain in abdomen
CECT: S/O perforated GB with impacted stone in neck



SURGERY: OPEN CHOLECYSTECTOMY.




CASE: NECROTIZING PANCREATITIS RADIOLOGICAL Drainage followed by MRPN in second month of illness

32 yrs male alcoholic
with respiratory distress, constipation,  pain , fever, vomiting in third week of NECROTIZING PANCREATITIS...

treated with minimal invasive approach...(as a first stage) with  RADIOLOGICAL Drainage of pus in lesser sac.
stabilizing him for few more weeks and than planned for necrosectomy after 6 weeks of illness.
discharged after 8 days of conservative treatment (OPN WIH ABSCESS IN THIRD WEEK) with drain now in situ...
pt on Normal diet, no fever, and soft abdomen...and residual necrosis in situ..(planned surgery after 2-3 weeks)



CASE: MINIMAL INVASIVE (Lap assisted) PANCREATIC NECROSAECTOMY

Middle aged male with pain in necrotizing pancreatitis and 3rd week of illness
kept conservatively for one more week
CECT:




taken up for necrosectomy on day 28 of illness
SURGERY: Lap assisted retroperitoneal  pancreatic necrosectomy



CASE: Tropical pancreatitis (Retrovirus positive) - LPJ

28 Yrs female with Retro virus positive for last 3 yrs..
with significant pain in abdomen for 2-3 yrs ..diagnosed as Chronic calcific pancreatitis

CECT:




SURGERY: LPJ



CASE : LOWER CBD STRICTURE With stone & cholangitis

55 yr male with sepsis, Pyogenic cholangitis .
Ostructing stone and lower cbd sticture.
STATUS : ERCP Failed.


SURGERY: Open CBD exploration & choledecho jejunostomy.

Monday, July 18, 2011

CASE: Mesenteric cyst......Whats the diagnosis....please comment ....


32 yrs female with recurrent abdominal distension
PAST HISTORY: 7 yrs back aspirated 3 liter of ascitis....> Asymptomatic for 3 yrs --> again aspirated 2 liters of ascitis......--> again developing abdominal distension.

NO OTHER SYMPTOMS, NO H/O KOCH'S, Family complete. , no fever, no wt loss,

CECT:










FLUID EXAMINATION: amylase 1300mg/dl    Triglyceride : 3 mg /dl    ADA : normal.... TLC: < 150 With predominant lymphocytes...

Gross: straw colored transparent fluid....

SURGERY: Exploration & removal of rt ovarian cyst.






Tuesday, July 12, 2011

CASE: Old age Huge Recurrent strangulated incisional hernia + HTN + IHD + Obesity

72 yrs female with Huge Recurrent strangulated incisional hernia + HTN + IHD + Obesity
came with acute onset vomiting , fever, distension, constipation, tachycardia
Past history: Lap chole and paraumbilical hernia repair 1.5 yrs back. (mesh plasty, lap)

CECT:



SURGERY:

anterior abdominal wall had total 11 defects all transmiting bowel



Discharged after 7 day.

CASE: Mirizzi syndrome type 1/2 with gangrenous cholecystitis (retro virus positive)

42 yr male and RV positive for 2 yrs on HAART
Developed sever pain in RHC and diagnosed as acute gangrenous cholecystitis

MRCP :   Phrygian Cap with Mirizzi type 2.





SURGERY: Open cholecystectomy and choledochoplasty:




pt discharged afte 6 days of surgery

CASE: MINIMAL INVASIVE PANCREATIC NECROSAECTOMY

28 yrs male with severe nerotizing pancreatitis
with sepsis.  on 28 days of illness


CECT:

SURGERY:
 Lap assisted minimal invasive pancreatic necrosectomy:



pt discharged on POD 7 with drain in situ..

CASE: LAPAROSCOPIC TRANS PERITONEAL NECROSECTOMY

Middle aged male with acute necrotizing pancreatitis  (Alcoholic). with persistent fever and nausea.
26 kg of wt loss. and on and off abdominal pain. 2 months following acute attack of necrotizing pancreatitis.

CECT:




SURGERY: TOTAL Laparoscopic Trans peritoneal necrosectomy, lavage and drainage.

opening of lesser sac

stomach lifted and lesser sac entered at the area of necrosis

removal of necrosis
placement of drain

post op
dirty necrotic material