Thursday, May 31, 2012

CASE: Strange case of abdominal poly trauma

35 yrs female had high spike of fever, sever pain, agony, distension, shortness of breath, and constipation for 6 days..with swelling (irreducible) in rt flank, tachycardia, and low urine out put..

( Patient had h/o with fall from 4 feet height and sudden onset pain and appearance of swelling in rt flank..
USG: S/O liver laceration/hematoma with mild free fluid, and intermascular colonic hernia
CT SCAN ON day 4:s/o liver tare,hematoma, moderate free fluid perihepatic,para colics, and intermascular hernia of colon
was kept conservatively, with application of abdominal binder..and was discharged on day 6..)

after resuscitation USG/CT was done
s/o gross free fluid and on aspiration it was infected bile.

plan: ERC And stenting followed by surgery (lavage and drainage)

ERC: S/o total loss of biliary tree structure with p/o major CHD/CBD transection, stenting was done

SURGERY: Findings: 1. Trapped interperital hernia in rt hypochondrium with transverse colon
2. 1.5 liter biliary peritonitis
3. liver leceration,hematoma in seg 5,6,
4. TOTAL HILAR SEPARATION WITH 2 CM SEGMENT LOSS OF CHD

procedure : 1. lavage, drainage, reduction of hernia, intarnal mascular interupted absorbable sutures (no mesh) was done.
2. cholecystectomy, hilar exploration identification of ducts, CBD, "T" TUBE insertion from Right duct to CBD-Duodenum, left system 10 fr drainage tube placement, sub and supara hepatic,pelvic, paracolic drains.
3.  Feeding jejunostomy










patient recovered and was discharged with SUBHEPATIC DRAIN, BLOCKED T TUBE, open left duct stent, with refeeding of bile via FJ. on POD 16.

Planned for DEFINITIVE HJ After 2 months.

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www.sidshospital.com

You Tube : Dr Keyur Bhatt




CASE: HILAR CHOLANGIO CARCINOMA

Middle aged male with Surgical obstructive jaundice, with Bilirubin more than 15 mg/dl
MRCP: S/O block in CHD

PLAN: ERC and stenting was done to reduce the bilirubin, Which decreased after 35 days to less than3,
Again CECT with angio done for liver:

SURGERY : Hilar excision, with lymph node dissection was done with  RYHJ, (Stented anastomosis on both the side with two ducts on each side with septoplasty )
patient recovered uneventfully post operatively and resection margins were free of tumor and all 10 L.N. were reactive..

www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

CASE: Chronic idiopathic pancreatitis

Middle aged male with pain in abdomen central, with back radiation, for 4 yrs and wt loss and anorexia for 2-3 yrs

Evaluated and found to have Chronic calcific pancreatitis with dilated ducatal system and multiple stones.

CECT: small pseudocyst in head of pancreas with multiples stones in MPD / dilated MPD. S/o chronic calcific pancreatitis


SURGERY: LPJ



www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

CASE: Massive lower GI bleed in CRF, Stercoral ulcers

Middle aged male with DM, HTN, CRF, on dialysis
had massive LOWER GI bleed,
h/o chronic constipation present.

COLONOSCOPY s/o large stercoral ulcers in entire rectum with profuse continues bleeding..and active spurting..

multiple sessions of endoscopy was done..over 3-4 days period., with more than 2 transfusion requirement of PCV per day..with all local, systemic measures applied, but bleeding was not controlled

Ultimately patient was taken up for rescue surgery: APR, With permanent colostomy.



pt recovered well in post op period and was discharged in due time..

www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

CASE: Choledochal cyst type 1 - CDC Excision and RYHJ

Young female with Chronic colicky pain in abdomen for 2 yrs

on evaluation found to have CDC Type 1.

CECT:



SURGERY: CDC Excision and RYHJ





pt discharged on POD 6.

www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

CASE: CA SIGMOID WITH LIVER METS

Middle age female with ca sigmoid with b/l liver mets, two in segment 2/3
and one in seg 8.

CECT: Confirmed the diagnosis

Surgery: anterior resection, diverting colostomy  with left hepatectomy and rt metastectomy



www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

CASE: Transgastric necrosectomy (alcoholic infected pancreatic necrosis)

young male with acute necrotizing pancreatitis before 2 months
with recurrent fever and abdominal pain, nausea, vomiting, weight loss, sepsis

CECT: S/o infected pancreatic multiloculated necrosis.


SURGERY: Transgastric pancreatic necrosectomy

patient discharged uneventfully after 7 days..

www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt

Friday, May 18, 2012

CASE: A rare case of Isolated amoebic abscess of spleen

Old yrs female with DM,HTN,IHD., And ARF.
Presented with Symptoms of UTI
Later evaluated and found to have splenic abscess... was treated conservatively initially..in view of medical risk factors..but did not responded and was referred for surgery

CECT:

SURGERY: open splenectomy

BX: S/O Amoebic splenic abscess .www.gisurgerysurat.com

www.sidshospital.com

You Tube : Dr Keyur Bhatt