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

CASE: GB TUBERCULOSIS

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

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. 

CASE: CA STOMACH

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




CASE: CA RECTUM With obstruction

old age patient with ca rectum and bostruction

CECT:


surgery: Hartmann's procedure



Bx: T3N1 adeno ca

CASE: CA RECTUM - LAR

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


CECT:


surgery : LAR With covering ileostomy.



BX: T3N2G1 Adeno ca.  

CASE: Corrosive type 5 gastric injury - Total gastrectomy and Roux en Y esophagoo jejunal pouch

young female with corrosive ingestion 5 months back, was on FJ feeds.

Scopy and Dye study reveled total contracted stomach with tight stricture at GE junction.

surgery: Total gastrectomy and Roux En Y jejunal pouch with esophago jejunal anastomosis + FJ




Dye study confirmed no leak on day 4 and pat was started on oral liquids and gradually on normal diet
discharged on day 8, without any undue complication.


CASE : Total colectomy and IPAA for FAP

Young female with FAP (familial adenomatous polyposis coli) with family history of malignancy to her mother  infact died of the same in early age

Surgery: LAP Assisted total abdominal proctocolectomy and ileal pouch anal anastomosis with covering loop ileostomy



patient was discharged on POD 5.