Tuesday, January 8, 2013

CASE: Liver trauma with biliary peritonitis

Young male with fall from 3rd floor during construction...
hemoperitoneum,  with mild distension of abdomen
hemodynamically stable. Hb 10, pulse 90bpm, BP: 110/70 on day 3.
day 4 started high grade fever with increased distension and septic look.
usg and
diagnostic taping done on day 3 s/o bile

surgery: exploratory laparotomy done and biliary peritonitis found.. lavage draingae..cholecystectomy and intra-op cholangiogram done s/o biliary leak from the laceration of segment 6.

drain kept inside and multiple drains in abdomen. + biliary stenting done with 7 x 10 fr stent.

patient discharged on OPD 9 with controlled biliary fistula draining 5-10 ml bile/day in drain.. hemodynamically stable and on normal diet.

CASE : Strange case with obstruction

elderly male presented with obstruction, distension, dehydration and toxemia
NCCT: S/O Small bowel obstruction with ? mass ? stricture in terminal ileum with grossly dilated proximal bowel loops and collapsed colon...

surgery: exploratory laparotomy and enterotomy and removal of foreign body (plastic sheet) impacted partially within diverticula and terminal ileum (causing obstruction)

patient was discharged post operatively with minor wound infection..recovered with dressing..

CASE: chronic pancreatitis with head mass -LPJ With head coring

middle aged chronic alcoholic and smoker male with pain in abdomen and 6 kg wt loss with pancreatic exocrine partial insufficiency. and type b pain

on evaluation found to have chronic pancreatitis.

SURGERY: LPJ with head coring

CASES: Chronic pancreatitis with head mass

CASE 1: Middle aged chronic alcoholic and smoker male with Chronic pancreatitis and head mass and biochemical obstructive jaundice

surgery: LPJ With head coring intra op frozen section negative for malignancy and final Bx: s/o chronic pancreatitis.

CASE 2: Young adult male with chronic alcoholic pancreatitis for 5 yrs and 8 kg wt loss ,

surgery: LPJ With head coring

CASE: Achalasia cardia - lap haller's myotomy with fundoplication

middle aged female with progressive disphagia and hypothyroidism
on work up detected with achalasia cardia

surgery: lap haller's myotomy and anterior fundoplication . patient was discharged on next day with soft diet

CASE : Emergency left hepatectomy for trauma and biliary leak

young male with alleged h/o trauma and liver tare, CECT s/o near complete transection of left lateral segment of liver with mild to moderate amount of free fluid in abdomen

viatly: pt stable initially, upto 6-8 hrs of trauma
Hb stable in 24 hrs but started having distension , distress on repeat usg found to have increase in free fluid

explored suspecting biliary peritonitis and rightly found along with necrotic liver left lateral lobe

surgery: left lateral hepatectomy and cholecystectomy and intra op cholangiogram - to confirm negative bile leak.

patient was discharged uneventfully on POD 7.