Dr. Keyur Bhatt - Gastrosurgeon

Wednesday, January 5, 2011

Isolated Pancreatic Tuberculosis^-www.drkeyurbhatt.in*

JOP. J Pancreas (Online) 2006; 7(2):205-210.

University of Pittsburgh School of Medicine. Pittsburgh, PA, USA

CASE REPORT

Context: Pancreatic tuberculosis is an extremely rare clinical entity, despite the high prevalence of tuberculosis worldwide. The pancreas is protected from direct environmental exposure; therefore most cases of pancreatic tuberculosis arise from contiguous infection from peri-pancreatic lymph nodes or rarely from hematogenous

spread. Pancreatic tuberculosis can present as a cystic or solid pancreatic mass mimicking pancreatic malignancy. Diagnosing pancreatic tuberculosis is a clinical challenge and most cases are diagnosed after surgical exploration for presumed pancreatic cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is being used more frequently for imaging and sampling of pancreatic lesions. Immediate cytopathologic examination of tissue sampled by EUS increases the diagnostic yield and is standard in many

institutions.

Isolated Pancreatic Tuberculosis

KUWAIT MEDICAL JOURNAL
Kuwait Medical Journal 2004, 36 (4):290-292

CASE REPORT

Tuberculosis of the pancreas is a clinical rarity and mimics pancreatic carcinoma both clinically and

radiologically. A 3 2 - y e a r-old Somali male patient presented with history of vague abdominal pain, weight loss, anorexia and jaundice. Radiological imaging showed gall stones, dilated common bile duct (CBD) and a hetrogenous pancreatic mass. Endoscopic retrograde cholangio pancreatography (ERCP) showed marked narrowing of the CBD with an impression of external compression. Cholecystectomy and holedochoduodenostomy (CDD) were performed after frozen section histopathology revealed the mass to be tuberculosis. P reoperative diagnosis of pancreatic tuberculos is requires a high index of suspicion and usually its diagnosis is established after surgical tre a t m e n t . T h e response to antituberculosis treatment is very effective.

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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....

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Friday, December 31, 2010

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

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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....

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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...