Sunday, March 31, 2013

case: Recto vesica fistula

middle aged male with h/o passage of air and fecal matter in urine for 3 months

on evaluation found to have recto vesical fistula following perforation of sigmoid diverticula

surgery: dismentling of fistula, repair or bladder, and resection and anastomosis of recto-sigmoid colon

You Tube : Dr Keyur Bhatt

CASE: Multiple diverticulosis of colon - TAC -IRA

OLD aged female with h/o peritonitis (2 liter) and laparotomy and lavage 1 yr back for perforated sigmoid diverticula..

one year later again she had perforation peritonitis and was operated again and sigmoid colostomy was made

later on evaluated and found to have multiple diverticulas in whole colon right from cecum to sigmoid...with high risk of future perforation and peirtonitis

PLAN SURGERY: Total abdominal coletcomy and ileo rectal anastomosis..with diverting ileostomy

patient was discharged on POD 5.

You Tube : Dr Keyur Bhatt

case: very starange! - 8 x 3 cm stone in CBD

Elderly female with pain in RHC and jaundice...on evaluation found to have ?? OMG - 8 X 3 CM stone in lower CBD  with CBD diameter 3.5 cm!!

surgery: open CBD Exploration with Choledecho duodenostomy and cholecystectomy.

You Tube : Dr Keyur Bhatt


Elderly male with constipation for 2 months and anemia, Dehydration, pre renal azotemia

past history of IHD, Hemiplagia,

X ray: s/o multiple air fluid levels

CT (PLAIN): s/o ? growth at IC region with dilated small bowel loops and collapsed colon

surgery: emergency Rt hemicolectomy with terminal ileal resection and ileo transverse anastomosis

the patient was discharged on POD 12.

You Tube : Dr Keyur Bhatt

CASE: CA RECTUM With obstruction

Elderly female with constipation and distension of abdomen for 7 days
past history of constipatioin for 1.5 yrs


CEA: 50

SURGERY: Emergency exploratory laparotomy and hartmann's procedure

patient was discharged on POD 10

You Tube : Dr Keyur Bhatt

CASE: HCC - Extended rt hepatectomy

Young male with non specific pain in abdomen and rt shoulder
initially evaluated and found to have ? liver abscess in rt lobe of liver...later on work up reveled Right lobe liver tumor


AFP: 5990.


SURGERY: Extended Right hepatectomy (resection of seg 4,5,6,7,8)

post op LFT: normal, patient was discharged on POD 7. 

CASE: CDC type 4A - Excision and RYHJ

Young female with RHC pain for 2 yrs on and off
on evaluation found to have CDC Type 4 a


SURGERY: CDC Excision and RYHJ

CASE: Mucinous cyst adenocarcinoma of pancreas

Middle aged male with HTN, COPD, Secondary PHT
Dull aching pain in central abdomen and left hypochondrium and palpable mass

usg / CECT: S/o mass arising from body of pancreas with solid cystic components..possiblity of mucinous cyst adenoma

SURGERY: distal pancreatectomy

patient was discharged on POD 4.

Bx: Mucinous cyst adenocarcinoma, lymphonodes and margin negative.

CASE : Right para adrinal tumor

young female with non specific pain in RHC region for 1.5 yrs
on evaluation found to have rt para adrinal highly vascular tumor, closely surrounded by liver, IVC, PV, CBD, pancreas

surgery: excision of tumor

pt was discharged POD 3.

You Tube : Dr Keyur Bhatt

Monday, February 25, 2013

CASE: LPJ With head coring

Young femle with pain in abdomen for 6 yrs and 10 kg wt loss

on evaluation found to have chronic pancreatitis with multiple stones in PD. (Tropical pancreatitis)

surgery: LPJ with head coring

patient discharged pain free on day 5. 

CASE: Large hiatus hernia - nissan's fundoplication

Middle aged female with persistent dyspeptic symptoms.. and chest pain
got done CXR, ECG, 2 D ECHO ,TMT, Conventional angiography as well found every thing normal

UGIE: Reveled huge hiatus hernia

CECT: confirmed it

surgery: lap reduction of hernia with  floppy nissans fundoplication
patient was discharged on POD 1 With normal diet.

CASE: LAP Splenectomy

 Middle aged female with ITP Not responding to conservative treatment

platelates persistantly bellow 20-30 thousand/cmm

surgery : Lap splenectomy

patient was discharged on pod 2. with platelate count of 1.7 lac/cmm

You Tube : Dr Keyur Bhatt


Middle aged male with dyspeptic symptoms

ON UGIE: Found to have ulcer in anturm with puckring bx taken s/o possibly granulomatous lesion

ACE & ASCA levels were normal

CECT: S/O mass in GB fundus region with regional liver & stomach  involvement.

plan: surgery - Radical cholecystectomy with lymphadenoctomy, transverse colonic sleev resection with distal gastrectomy and Roux en Y gastro jejunostomy.

BX: Surprisingly Primary tuberculosis of GB.
Patient is started on AKT

You Tube : Dr Keyur Bhatt

CASE: D 1 CARCINOID - distal gastrectomy with RYGJ

Middle aged male with acid peptic symptoms
On evaluation found to have G1 neuroendocrine tumor of stomach/duodenum (WHO 2010)

CECT s/o lesion in D1 on posterior wall

EUS: S/o one place involvement of submucosa and ? mascularis as well

S. Chromogrannin A: 288

surgery: Distal antrectomy and D 1 resection with regional lymphadenectomy

BX: Well differentiated neuroendocrine tumor of stomach with full thickness involvement of submucosa, all lymph nodes are negative.

You Tube : Dr Keyur Bhatt


Old aged male with gastric outlet obstruction and hemetemesis on evaluation found to have well differentiated tumor of stomach

surgery: D2  Distal Gastrectomy + colonic resection

You Tube : Dr Keyur Bhatt

CASE: CA RECTUM With obstruction

old age patient with ca rectum and bostruction


surgery: Hartmann's procedure

Bx: T3N1 adeno ca


Old age male with HTN, DM  with bleeding P/R. On work up found to have ca lower 1/3 of rectum


surgery : LAR With covering ileostomy.

BX: T3N2G1 Adeno ca.