Saturday, June 23, 2012

CASE: NCPF With recurrent bleeding and failed endotherapy

middle aged female with recurrent UGI bleed , more than 35 glue injection sessions

repeated episodes of gastric and duodenal varices bleeding

Surgery: splenectomy for decompression and liver BX

BX: NCPF, No evidence of cirrhosis of liver


Middle aged male with Acute Gall stone Necrotizing pancreatitis
day 35, not improving with conservative management

CECT: S/o organized infected pancreatic necrosis with air foci within the collection

SURGERY : OPEN pancreatic necrosectomy

You Tube : Dr Keyur Bhatt

CASE: CA body of pancreas with chronic pancreatitis - distal pancreatectomy with splenectomy

middle aged male with pain in central, left abdomen

on USG / CECT : Found to have chronic pancreatitis with stones in head with dilated PD 9 mm and mass of around 3 x 4 cm in body of pancreas with central area of necrosis..

CA 19.9 : 65

Endo Sono FNAC:  confirmed the diagnosis of adeno ca of pancreas

SURGERY: Distal pancreatectomy with splenectomy, removal of stones via duct from head & roux en Y pancreatico jejunostomy

patient was discharged on POD 6

FINAL BX: G2 T2N0 All margins negative without lymphovascular invasion.

You Tube : Dr Keyur Bhatt

CASE: Revision Frey's for Old Pustow

36 yrs male operated for Pustow's procedure for chronic pancreatitis before 20 yrs
having pain in abdomen initially type A now converted to Type B
and dependent on daily high dose of analgesics

evaluated and found to have strictured previous anastomosis with dilated head, neck ducts with stones in duct..and dilated duct in tail as well

CECT: S/O chronic pancreatitis with strictured duct and dilated duct in head and tail with impacted stone

decision of revision surgery was taken after 5 months of conservative treatment

SURGERY: Revision pustow's with Frey's procedure.

patient was discharged on pod 6 with relieved pain..

You Tube : Dr Keyur Bhatt

CASE : Chronic pancreatitis - LPJ

young female with chronic abdominal pain for 8 yrs initially Type A pain now having type B pain for around  2 months
No endocrine or exocrine insufficiency..

SURGERY: LPJ (Lateral pancreatico jejunostomy with head coring )

You Tube : Dr Keyur Bhatt

Monday, June 11, 2012

CASE: Unusual case of bowel ischemia

42 YRS male, non diabetic, non smoker, non Hypertensive
presented  with sepsis, shock, ARF (urea 91, Creat 2.1), P: 140, BP: 90/60 On inotrops..drowsy,

 ( p/h/o: pain in abdomen for 2 days and USG at that time s/o free fluid in abdomen (moderate) with non visulization of appendix / ? perforated appendix...and hence operated for open appendectomy, post op patient did well for 2-3 days , started having fever, distension, pain, low out put on POD 3....AND was referred on POD 7 night )

Abdominal drain was draining dirty , purulant fluid, after adequate rehydration, USG Done s/o dilated aperestaltic bowel loops with multiple pockets of collection through out the abdomen (on aspiration which drained feculant material )

ABG: WAS s/o over compensated alkaline pH.

Was taken up for surgery suspecting stump blow out / cecal perforation with peritonitis

OF SURPRISE:  It was TOTAL MESENTERIC ISCHEMIA WITH GANGRENE OF SMA region..with 1.5 liter of toxic fluid in abdomen...unfortunately ...we could not do much for the patient....