Dr. Keyur Bhatt - Gastrosurgeon

Wednesday, May 25, 2011

CASE: Ca Cecum with lower GI massive bleeding + GSD + LT indirect huge inguinal hernia + CA urinary bladder^-www.drkeyurbhatt.in*

57 yr male with H/O two episodes of TIA 7 Days back started on asprin. Admited under PHYSICIAN
c/o GI bleeding in the form of melena...Hb dropped to 8 from 14 in 4 days
subjected to scopy: BY GI PHYSICIAN
mass in cecum with active bleeding..
RADIOLOGIST: CECT: Detected CA CECUM, CA BLADDER, GSD + Left Inguinal huge hernia..

CARDIOLOGIST: 2D ECHO: S/O 36 % EF

ANESTHETIST: Epidural anesthesia.

G I SURGEON: Rt hemicolectomy, cholecystectomy, preperitoneal mesh plasty.

URO SURGEON: TURBT

Discharged on POD 6... fortunately both T 1 malignancy....pt cured.....

TEAM EFFORT.......made him go home in time .....

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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

Saturday, May 21, 2011

CASE: CDC with ca in situ^-www.drkeyurbhatt.in*

22 yrs male with lower CBD narrowing leading to cholangitis diagnosed in 2001
stented...bx and cytology negative..

insitu stent for 10 yrs now presented with cholangitis with stone and dilated CBD
stent, stone removed...and re stented..and Rx conservatively...

after 2 months two stents placed to dilate the lower Stricture..no e/o malignancy..
ON CECT was looking like CHOLEDOCHAL CYST ?

SURGERY: Plan: side to side bilio enteric roux en y anastomosis..
Intra op: was looking more of CDC TYPE 1 with smooth lower end tapering and dilated fusiform mid CBD..OF AROUND 3 CM..

PLAN changed and decided to remove CDC (as there are around 20% chance of development of malignancy )....AND Hepatico jejunostomy...was done....after total Excision of CDC..

Pt discharged on pod 6.

HISTOLOGY: CARCINOMA IN SITU IN CHOLEDOCHAL CYST...NO E/O INVASION...L.N. NEGATIVE....

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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: Gall stone + CBD Stones with lower CBD Stricture^-www.drkeyurbhatt.in*

56 yr male with cholangitis
lower end bening long stricture with multiple CBD stones...ERC failed.

Open surgery and drainage: with bilioenteric anastomosis..

post operatively pt recovery was smooth and was discharged in due time..

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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: BBS TYPE 2 ? PHB status PSRS 2008 & Open Chole in 1995^-www.drkeyurbhatt.in*

35 yrs female with h/o high spiking fever
In toxic cholangitis...
TLC : . 35K
with p/h/o open ccx in 1995 and massive bleeding at that time in Udaypur..
asymptomatic for 6-7 yrs
developed splenomegaly...and varices...and episode of cholangitis...
Diagnosed as PHB (Portal hypertensive biliopathy- due to EHPVO) Stented and PSRS Done in SIR GANGARAM HOSPITAL IN 2007.

later stent removed,

Again developed cholangitis 2- 3 episodes before this episode..
taken up for ERCP and with great difficulty GE physician could enter CBD Beyond stricture...and place 5 fr stent..which was draining pus

DIAGNOSIS: Portal hypertensive biliopathy ? Benign biliary stricture type 2. ( ischemic stricture following Open chole- bleeding...) status PSRS status Open cholecystectomy with cholangitis

ACTION: Stenting and relief from cholangitis...nutritional build up...
SURGERY: Open hepatico jejunostomy...