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.

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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.

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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.


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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





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

CASE: Liver hydatid with large cyst and multiple daughter cysts






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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 



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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



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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

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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

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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.

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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

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