CASE: ? PRIMARY TUBERCULOSIS OF PANCREAS AND PERI PANCREATIC NODES^-www.drkeyurbhatt.in*

13 Yrs child with h/o pain in epigastric region for last 5 yrs..with back radiation. . . associated with nausea...anorexia....failure to thrive...
was ultimately recently diagnosed as chronic pancreatitis...with dilated duct...and bulky head....
ERCP tried but cannulation was failed....

Referred for surgical management....rest of the work up was completed and diagnosis of TROPICAL VARIETY OF CHRONIC  PANCREATITIS was made..

CECT:

MRI:

SURGERY: LATERAL PANCREATICO JEJUNOSTOMY
FINDINGS: Were Caseating node over head of pancreas...near gastro colic vein...and peri pancreatic few nodes with caseation milking out cheesy material...
MPD was 10 mm and full of cheesy pus......

drained and LPJ done....

www.gisurgerysurat.com/

www.drkeyurbhatt.in/

www.sidshospital.com

 

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

ITS FIBROLAMALAR VARIENT OF HCC^-www.drkeyurbhatt.in*

70 yrs female with dull aching pain in RHC region no other positive symptoms...
On examination Huge liver Mass...

AFP & CEA LEVELS ARE NORMAL
LFT, CBC,RFT : ALL NORMAL...

ARTERIAL PHASE

PORTAL PHASE

DELAYED PHASE 

ANGIO RECONSTRUCTION 

www.gisurgerysurat.com/

www.drkeyurbhatt.in/

www.sidshospital.com

 

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

CASE: CONGENITAL DIAPHRAGMATIC HERNIA PRESENTED IN ADULTHOOD^-www.drkeyurbhatt.in*

Incidetaly detected Congenital diaphragmatic hernia......explained and Reassurance given....surgery is needed only in case of symptoms....

www.gisurgerysurat.com/

www.drkeyurbhatt.in/

www.sidshospital.com

 

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

CASE : Sad and Strange-- perforation in both Jejunal limbs of Previous J-J & LPJ done in 2008 for Chronic pancreatitis^-www.drkeyurbhatt.in*

Past history:
21 yrs boy with recurrent pain in abdomen...diagnosed as chronic pancreatitis and underwent Pustow's procedure in 2008, Eight days post op had acute obstruction and underwent re laparotomy...(Hydrabad)

remain okey for about  6 months ...than started developing recurrent episodes of pain in abdomen...all the time thought of sub acute obstruction / ? recurrent pancreatitis....became addict to Dynapar / Contromol...

developed acute intestinal obstruction...in Jan 2010...and once again was operated and adhesiolysis done....(mumbai)
again having multiple episodes of pains......was planned of Head corring and revision of surgery of Pancreas in Mumbai...admitted and evaluated for surgery but in view of malnutrition and low albumin deferred of surgery...and 1 month TPN given...and discharged to build up...

Again started of having pain ...got admitted...and thought of adhesions / ? pancreatitis...2-3 days treated conservatively....not responding to Rx and started more detoriating ....CECT was done....and it was peritonitis...
I got REF....and I had To Explore .....for the fourth time....and Oh My God....
he had 2.5 liters of peritonitis ...3 days old...already on Inotrops and low albumin..sepsis...
and Two perforations in both the limbs proximal of Previous J-J......horrible...just 1 feet from DJ...

WE SHOULD  RULE OUT ALL ORGANIC CAUSES BEFORE LABELING THAT PATIENT IS PSYCHOTIC....OR ADDICT TO ANY MEDICINE.................

www.gisurgerysurat.com/

www.drkeyurbhatt.in/

www.sidshospital.com

 

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

CASE: Grade IV liver Trauma (Once thought unsurvivable now .......Child Back to School......)^-www.drkeyurbhatt.in*

PAST HISTORY:

16 yrs boy with Blunt trauma abdomen --> liver laceration and hemoperitoneum (2 liters), hemodynamically unstable
Explored--> hemostasis tried....massive bleeding---packing done

remained on venti for 2 days...bleeding continue...>10 blood / products given...

PRESENTATION : Cont. bleeding even after packing..and Hemodynamic unstability (again more than 1.5 liter blood loss)

RE EXPLORED AFTER 48 hrs of previous surgery & hemostasis achieved...drains kept in Morrison's puch and pelvis.......gradually stabilized...Extubated after 6 critical  days....pelvic drain removed...started on Oral diet...

developed Biliary fistula from injured peripheral seg 7 of liver...Per cutaneous Malacot catheter placed in collection near seg 7...and drain removed....fistula localised.....discharged of hospital after 1 month stay...
ERC and stenting done...gradually fistula out put decreased.....unfortunately developed stent blockage and cholangitis...
Re admitted and stent changed with smaller caliber straight flap stent on Rt side...
External Fistula healed...and malacot removed....no residual collection....

Once thought unsurvivable now .......Child Back to School......

last MRI before episode of Cholangitis...
showing healing laceration and
compensatory hypertrophy of left lobe of Liver

www.gisurgerysurat.com/

www.drkeyurbhatt.in/

www.sidshospital.com

 

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon