Thursday, December 13, 2012

case: lap splenectomy for multiple splenic abscesses.

young male with daily high spiking fever for 12 days
on work up found to have multiple splenic abscess

CECT:





SURGERY: LAP. Splenectomy

patient was discharged on POD 2.

CASE: CA RECTOSIGMOID - AR

Elderly male with frequent lower gi bleeding and h/o severe aortic stenosis (valve area less than 10 mm) and atherosclerotic changes in descending abdominal aorta

on evaluation found to have ca recto-sigmoid junction and unfortunately patient was refuted from surgey in two major onco-surgical hospitals due to medical fitness issues..

patient was worked up and taken up for surgery

surgery: Anterior resection and primary anastomosis -
whole surgery was done in segmental epidural anaesthesia maintaining Vitals through out normal, and patient did not stayed a single day in ICU. Was started on oral diet by day 3 and discharged on day 6 uneventfully,







Bx: T3N0 moderatedly differentiated adenocarcinoma of rectum.



Wednesday, December 12, 2012

CASE: Acute mesenteric ischemia due to acute block in SMA

Middle aged male with pain abdomen for last 3-4 days acute in onset..central abdominal pain
with vomiting ...past history of CHD and coronary stenting done before 3 yrs

CECT  was done and was s/o acute sma block with thrombosis and proximal bowel gangrene and distal bowel ischemia...along with that air pockets in all lobes of liver..





taken up for surgery:

DAY 1: laparotomy and Superior Mesenteric Aartery exploration and thrombectomy and closure

Day 2: Re -exploration, proximal bowel resection anastomosis ..lavage and drainage.



patient was on inotrops and venti support for 7 days and was gradually improved  and started on oral diet and discharged on day 12.

CASE:myofibroblastic tumor from colon - excision with wedge resection

Young male with mass in RHC region for 3 months
No significant GI or other symptoms
progressively increasing in size

surgery: wide local excision with Gastric sleeve resection, pancreatic sleeve in tail region and colonic (transverse colon-segmental involvement) resection and anastomosis


patient was discharged on POD6. Uneventfully
Bx: IHC  : s/o myofibroblastic tumor with low mitotic index (1 mitotic /50 fields )

Thursday, November 29, 2012

case: Lower gi bleed - mackel's divertucula

young male with history of enteric fever and positive tests for the same
with lowe GI bleed daily needing transfusion of 2 pcv. (total 8 given in 4 days) and still Hb was 7.5.

on further evaluation found to have bleeding from mid ileum (on ileo-colonoscopy) and all terminal ileal ulcers were shallow and healing.

taken up for surgery and found to have gross bleeding from mackel's diverticula (3 x 5 cm)size  with no blood proximal to diverticula

SURGERY: Resection and anastomosis of mackel's diverticular segment of ileaum

patient was discharged on POD 6.

case: perforated sigmoid diverticula - left hemicolectomy and coloraectal anastomosis

old aged male with DM , HTN,
C/o pain in lower left abdomen for 7 days
high grade fever, diarrhoea

found to have perforated sigmoid diverticula and localized abscess

SURGERY: left hemicolectomy and coloraectal anastomosis

patient was discharged on pod 7.

CASE: Massive Lower GI bleed for bleeding enteric ulcers - terminal ileal resection and ileo transverse anastomosis

CASE: young male with history of fever and abdominal pain with massive lower GI bleed.. on evaluation found to have sever ulcerations in terminal ileum with significant active bleed

with profound shock and high inotrops and sepsis

surgery: terminal ileal resection with ileo-transverse anastomosis.. was diascharged on POD 9.



CASES: Small bowel carcinoids with SAIO And bowel ischemia.

case 1: Old aged female with chronic constipation and dull aching pain in abdomen with recent onset mas in RIF 
on evaluation found to have ( suspected ) terminal ileal carcinoid with bowel ischemia.

surgery: Rt hemicolectomy and ileal resection with anastomosis.




CECT:




BX: CARCINOID OF TERMINAL ILEUM


case 2: old aged male with known HTN And epileptic. found to have similar complaints and was diagnosed with metastatic carcinoid with SAIO and bowel ischemia

surgery: Extended Rt hemicolectomy and terminal ileal resection







CASE: Hydatid cyst of liver - drainage and partial cysto pericystectomy

CASE: Liver hydatid with large cyst and multiple daughter cysts






CASE: Marotation with duodenal obstruction

Young male with persistant vomiting and recurrent upper GI Symptoms
on evaluation found to have malrotation of gut with small bowel volvulous

surgey: surgical reduction and release of Ladd band and duoduno-jejunostomy 




Case: ANP With infected pancreatic necrosis

old aged (gall stone) necrotizing pancreatitis with sepsis, hypotension,early ARDS
day 28 of ilness was taken up for pancreatic necrosectomy

cect:




was done with conventional approach (open pancreatic necrosectomy and feeding jejunostomy) and was discharged in due time following surgery



case: ca rectosigmoid - hartmann's procedure

Old aged female with acute onset obstipation over recent 3-4 months of constipation
on evaluation found to have Ca recto sigmoid with acute obstruction
CECT:



SURGERY: Radical left hemicolectomy and hartmann's procedure:



patient was discharged on day 12 of surgery.

Bx: adenocarcinoma of rectosigmoid G2T2N0

CASES : IBD - Total coletcomies

case 1.Recently diagnosed UC for 1 month patient had TOXIC MEGACOLON WITH PERFORATION

SURGERY: Total abdominal colectomy with end ileostomy ..patient was discharged on POD 8.





case 2. : Middle aged male presented with history of few days diarrhoea and sudden lower GI bleeding..and shock..on evaluation found to have IBD with massive LOWER GI BLEED (Colonic). but by the time patient was in profound shock..high inotrops and Early ARDS.

emergency TOTAL ABDOMINAL COLECTOMY and end ileostomy was done.


unfortunately we lost the patient of refractory ventricular tachycardia on day 7.



Friday, November 2, 2012

case : short segment bowel gangrene wiyh mesenteric emboli..

old aged female with 3 days pin in abdomrn and mild sepsis
on evaluation found to have embolic gangrene of ileum and localized perforation

SURGEY: Segmenal resection and anastomosis

EHPVO -PSRS

42 yr female with recurrent bleeding from esophageal and gastric varices more than 11 sessions of endo therapy and dyspite developement of recurrent varices...and hypersplinism

SURGERY : PSRS (proximal spleno renal shunt with splenectomy)
pre op portal pressure 38mm of water post shunt droped to 9.



post op patient sent home on day 5. 

Thursday, November 1, 2012

case: bowel gangrene with sepsis and MODS With acute mesenteric venous ischemia

middle aged female with severe pain in abdomen and metabolic acidosis septic shock....after three days of history
and recent onset DM
CECT : s/o acute smv thrombosis with proximal bowel gangrene with peritonitis...

Surgery: emergency laparotomy and lavage and resection of gangrenous jejunum and single layer anastomosis at Dj flexure...

at the time of surgery Nor adr was at 12ml/hr std dilution, heparin oninfusion 3ml/hr.
dopa 10ml/hr..creat: 3.5   TLC: 34,000  and s. albumin 1.4  hb:6.8 with this BP: 90/50.pulae:160/min..

fortunately patient came out of sepsis slowly...and on the path of goin home finally after 25 days of surgery....


Case: mal rotation with small bowel volvulous

17 yr child with bilious vomiting and recurrent pain in abdomen
on investigation found to have  small bowel volvulous with mal rotation

Surgery: lap assisted derotation of bowel and release of lap band and appendectomy


Sunday, September 23, 2012

CASE: Liver laceration with tare - Emergency left hepatectomy

young female with 6 weeks amenorrhoea and h/o fall from 3rd floor height
and hemoperitoneum
CECT: S/O LIVER left lobe with seg 8 extension hematoma and laceration with moderate free fluid in abdomen
however pt remained hemodynamically stable for 2 days, Hb remained stable around 10 after initial transfusion of two PCV.

Developed distension, fever, sepsis on day 3
repeat CT S/o gross free fluid with increased non enhancing liver paranchyma (on aspiration found to have blood and bile mixed peritonitis)

taken up for surgery and EMERGENCY LEFT HEPATECTOMY with ligation of left hepatic ducts was done (confirmed with intra op cholangiography) along with MTP.
post op pat had minor biliary lieak from paranchyma draining 20 mlbile/day..and was discharged with drain on normal diet on POD 11.





CASE: Chronic pancreatitis with obstructive jaundice - LPJ With CDD.

36 male with h/o  chronic alcohol intake
having chronic pancreatitis initially type A pain but now having type B
no endocrine or exocrine insufficiency
h/o jaundice for last 10 days

on CECT: found to have chronic calcific alcoholic pancreatitis with lower CBD long stricture and dilated proximal CBD AND IHBRD.

CA: 19.9 : NORMAL

surgery: LPJ With CDD. patient discharged on  POD 6. With normal diet.





CASE : Acute bowel gangrene of proximal jejunum

65 yrs male with pain in abdomen for 2 days sever, with sepsis, ARF, 
On evaluation with CT : found to have jejunal gangrene starting from DJ flexure to early ileal loops

surgery: Resection and primary anastomosis at DJ Flexure after mobilizing duodenum 4th part
patient diascharged on day 10 after surgery with normal diet