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






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.

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.






CASE: CA CECUM - EXTENDED RT HEMICOLECTOMY

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.


CASE: CA RECTUM With obstruction

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

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

? 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. 

BX, IHC: Hepato cellular carcinoma.

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

MRCP:




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.