Friday, March 18, 2011

CASE : Complete intestinal malrotation with Cecal Volvulus^-www.drkeyurbhatt.in*

38 yrs male
pain in abdomen for 3 days with differential abdominal distension more in LIF
Associated with constipation and nausea
p/h/o open appendectomy 15 yrs back from RIF incision..

USG : S/O volvulus of sigmoid colon
X RAY: S/O volvulus of colon arising from pelvis with few more air fluid levels
suspected diagnosis: Sigmoid Volvulus..

Sigmoidoscopy: normal...

CECT : Large bowel obstruction with ? p/o  Malrotation with kink midway ? cecal volvulus..with diameter of colon . >10 cm.. and dilated proximal bowel loops..



  



SURGERY:  (Exploratory Laparotomy): Derotation, untwisting and division of a LAD Band and repositioning of cecum in left iliac fossa (as this is a case of complete intestinal malrotation type 3) and decompression.















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Thursday, March 10, 2011

CASE: CYSTO DUODENOSTOMY^-www.drkeyurbhatt.in*

21 Yr girl with h/o acute Idiopathic  pancreatitis 6 mths back
resolved with development of pseudocyst.

Significantly increasing in size and causing gastric outlet obstruction and visible lump..

CECT:




SURGERY: Cysto duodenostomy (the most Dependant portion of cyst)


Pt is now on oral diet and ready for discharge..

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Tuesday, March 8, 2011

CASE: ACUTE MESENTERIC VENOUS THROMBOSIS & BOWEL GANGRENE^-www.drkeyurbhatt.in*

28 yrs male with pain in abdomen for 3 days
distension, nausea, Melena
Rising TLC and agony

CECT:

SURGERY: Laparotomy and resection of gangrenous segment of jejunum (as stated in scan with venous thrombosis) and stoma.
(1.5 liters of toxic fluid and gangrenous distal jejunum)





Pt about to go home... with distal mucus fistula feeding....

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CASE: LAP. RETROPERITONEAL NECROSECTOMY^-www.drkeyurbhatt.in*


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Monday, March 7, 2011

CASE: LAP. RETROPERITONEAL NECROSECTOMY^-www.drkeyurbhatt.in*

38 yrs male with Acute Necrotising pancreatitis
 TLC ; > 18,000, & Fever...Pain in abdomen with distension and discomfort...

S/O Infected Pancreatic necrosis.

CECT:
Infected pancreatic necrosis inlasser saac, and retroperitoneum
going in mesentery and behind descending colon


SURGERY: Total Retroperitoneoscopic necrosectomy
TIME : 3 hrs. BLOOD LOSS: 50 ML
1 Tray full necrosis & 500 ml of pus.
ICU STAY: 1 DAY  ORAL DIET : From day 2.

Surgery:

pre op left flank buldge
main lesser sac cavity
Infected necrosis

Total baring of mesenteric vessels and removal
of necrosis
drain placement
necrotic material

post op with just two drains

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