84 yrs male with pain in abdomen and fever with distension and diarrhoea.. HBsAg + ve.
however vitals stable with 76 pulse and 100/70 BP.
Operated for head and neck malignancy and post of chemoradiation 5 yrs back.
CT: S/O jejunal diverticular perforation with localized abscess.
Initial trial of Pig tail drainage was given considering age and other co-morbidity.
however pt failed to improve after 48 hrs and counts increased and pig tail started draining bilious fluid which initially was frank pus only. and tachycardia as well.
was taken up for surgery with explained due risks...
surgery: went smooth and operated in only epidural anaesthesia and resection anastomosis of perforated jejunal diverticular segment was done..
post op was very dramatic :
pt remained stable for 3 days..gradually started on liquid diet..and was about to be shifted to ward..suddenly had cardiac arrest with Anterior wall MI. --- CPR for 5 mins..revived-- on ventilator...and inotrops...LMWH..Asprin..
gradually improved in 48 hrs and extubaed...started on oral diet..was again about to be shifted from ICU to ward.. now on POD 7..Suddenly had massive melena... Hb Dropped to 6 from 11. total 4 transfusion given..hemodynamics maintained, next day melena continued..another 3 transfusions given..
CECT ABDOMEN: and UGIE: Done s/o stress related severe gastritis and diffuse massive bleed from stomach.
PPI infusion started and bleed gradually settled....pt finally discharged walking to home on POD 14...
www.gisurgerysurat.com
www.sidshospital.com
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however vitals stable with 76 pulse and 100/70 BP.
Operated for head and neck malignancy and post of chemoradiation 5 yrs back.
CT: S/O jejunal diverticular perforation with localized abscess.
Initial trial of Pig tail drainage was given considering age and other co-morbidity.
however pt failed to improve after 48 hrs and counts increased and pig tail started draining bilious fluid which initially was frank pus only. and tachycardia as well.
was taken up for surgery with explained due risks...
surgery: went smooth and operated in only epidural anaesthesia and resection anastomosis of perforated jejunal diverticular segment was done..
post op was very dramatic :
pt remained stable for 3 days..gradually started on liquid diet..and was about to be shifted to ward..suddenly had cardiac arrest with Anterior wall MI. --- CPR for 5 mins..revived-- on ventilator...and inotrops...LMWH..Asprin..
gradually improved in 48 hrs and extubaed...started on oral diet..was again about to be shifted from ICU to ward.. now on POD 7..Suddenly had massive melena... Hb Dropped to 6 from 11. total 4 transfusion given..hemodynamics maintained, next day melena continued..another 3 transfusions given..
CECT ABDOMEN: and UGIE: Done s/o stress related severe gastritis and diffuse massive bleed from stomach.
PPI infusion started and bleed gradually settled....pt finally discharged walking to home on POD 14...
www.gisurgerysurat.com
www.sidshospital.com
You Tube : Dr Keyur Bhatt
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
