Sunday, March 31, 2013

case: Recto vesica fistula^-www.drkeyurbhatt.in*

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

on evaluation found to have rectovesical fistula following perforation of sigmoid diverticula

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







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CASE: Multiple diverticulosis of colon - TAC -IRA^-www.drkeyurbhatt.in*

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

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case: very starange! - 8 x 3 cm stone in CBD^-www.drkeyurbhatt.in*

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.






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CASE: CA CECUM - EXTENDED RT HEMICOLECTOMY^-www.drkeyurbhatt.in*

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.
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CASE: CA RECTUM With obstruction^-www.drkeyurbhatt.in*

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

ON CECT: found to have CA RECTO-SIGMOID

CEA: 50

SURGERY: Emergency exploratory laparotomy and hartmann's procedure


patient was discharged on POD 10

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CASE: HCC - Extended rt hepatectomy^-www.drkeyurbhatt.in*

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

? HCC  ?HEPATOBLASTOMA  ?FLC

AFP: 5990.

 TRIPHASIC CECT:




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




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


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CASE: CDC type 4A - Excision and RYHJ^-www.drkeyurbhatt.in*

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

MRCP:




SURGERY: CDC Excision and RYHJ





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CASE: Mucinous cyst adenocarcinoma of pancreas^-www.drkeyurbhatt.in*

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.


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CASE : Right para adrinal tumor^-www.drkeyurbhatt.in*

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.

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Monday, February 25, 2013

CASE: LPJ With head coring^-www.drkeyurbhatt.in*

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. 


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CASE: Large hiatus hernia - nissan's fundoplication^-www.drkeyurbhatt.in*

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.


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CASE: LAP Splenectomy^-www.drkeyurbhatt.in*

 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

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CASE: GB TUBERCULOSIS^-www.drkeyurbhatt.in*

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

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CASE: CA STOMACH^-www.drkeyurbhatt.in*

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




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CASE: D 1 CARCINOID - distal gastrectomy with RYGJ^-www.drkeyurbhatt.in*

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.

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