CASE: Jejunal diverticular perforation at extreme of age with lots of drama^-www.drkeyurbhatt.in*

84 yrs male with pain in abdomen and fever with distension and diarrhoea.. HBsAg + ve.
however vitals stable with 76 pulse and 100/70 BP.
Operated for head and neck malignancy and post of chemoradiation 5 yrs back.

CT: S/O jejunal diverticular perforation with localized abscess.
Initial trial of Pig tail drainage was given considering age and other co-morbidity.

however pt failed to improve after 48 hrs and counts increased and pig tail started draining bilious fluid which initially was frank pus only. and  tachycardia as well.

was taken up for surgery with explained due risks...
surgery: went smooth and operated in only epidural anaesthesia and resection anastomosis of perforated jejunal diverticular segment was done..

post op was very dramatic :

pt remained stable for 3 days..gradually started on liquid diet..and was about to be shifted to ward..suddenly had cardiac arrest with Anterior wall MI. --- CPR for 5 mins..revived-- on ventilator...and inotrops...LMWH..Asprin..

gradually improved in 48 hrs and extubaed...started on oral diet..was again about to be shifted from ICU to ward.. now on POD 7..Suddenly had massive melena... Hb Dropped to 6 from 11. total 4 transfusion given..hemodynamics maintained, next day melena continued..another 3 transfusions given..

CECT ABDOMEN: and UGIE: Done s/o stress related severe gastritis and diffuse massive bleed from stomach.

PPI  infusion started and bleed gradually settled....pt finally discharged walking to home on POD 14...

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CASE: Perforated sigmoid diverticula with morbidly obese patient^-www.drkeyurbhatt.in*

Middle aged female with MORE than 45  BMI , DM , HTN

Presented with pain in abdomen lower back ache and diarrhoea...with distension..

CECT: S/O perforated Sigmoid colon diverticula with abscess in pelvic cavity

SURGERY : exploratory Laparotomy and resection of sigmoid and descending colon (diverticula barring segment) with intra op bowel lavage and colo rectal anastomosis and proximal diverting ileostomy. 

pt was kept on ventilator for 3 days post op and gradually weaned off..started on oral liquids by day 4 and sent home with minor wound infection on POD 13.

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CASE: CA GB with jaundice^-www.drkeyurbhatt.in*

Middle aged female with gradually rising jaundice and pain in abdomen.

worked up and s/o cholangio carcinoma involving CHD with SOJ, was ERC And stented in Delhi..later on wroked up in TATA memorial and planned for surgery

Pt came to surat, was evaluated again and found to have CA GB. With SOJ. St stented. now jaundice came to normal.

Surgery:  Radical cholecystectomy with seg 4b , 5 resection of liver and CBD Excision with RYHJ & Lymphadenectomy. without blood transfusion.

Pt discharged on POD 7.

HPE: S/O moderately differentiated Adenocarcinoma of GB , With 1 node positive, liver, proximal and distal CBD margins free of tumor. T3,N1,M0.

Will be subjected to adjuvant chemotherapy.

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CASE: INCIDENTAL CA GB - COMPLETION RADICAL CHOLECYSTECTOMY^-www.drkeyurbhatt.in*

CA G.B: routinely detected GB malignancy, mostly by imaging.

Missed Ca GB: detected during surgery, and missed during prior work up or imaging.

Incidental CA GB: cholecystectomy done and histology shows GB mailgnancy, or pt presents later on with features of CA GB after cholecystectomy, complete/partial.

----------------------------------------------------------------------------------------------------------------

60 yrs male presented with pain in rt upper quadrant following cholecystectomy done 2 yrs back in Bihar.
histology report of GB: not available.
USG/ CECT: S/o mass in liver bed, in seg 4b and 5. likely incidental ca GB.

CA 19.9: NORAML.

Surgery: COMPLETION radical cholecystectomy with liver resection and lymphadinectomy, With duodenal sleeve resection and port site excision. no blood transfusion was given.

pt was discharged on POD 6.

HPE: S/O well differentiated adenocarcinoma of GB, all resection margins are free of tumor, and all lymph nodes are negative..port site nodule positive for malignancy...

pt is now subjected to adjuvant chemotherapy.


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CASE: Multiple polyposis coli with ca colon^-www.drkeyurbhatt.in*

Middle aged male with recurrent colicky  pain in abdomen for more than 1 year,DM, HTN.

CECT: S/o growth near splenic flexure with dilated proximal large bowel.  and an enlarged single node near splenic flexure, rest NAD.

COLONOSCOPY: S/o non negotiable growth in splenic flexure, with two polyps in descending colon, bx taken.

Plan : Lap assisted redical left hemicolectomy and intra op proximal colonoscopy  to look for polyps..sos total colectomy..

SURGERY: LAP Assisted radical left hemicolectomy done, intra op proximal colonoscopy done s/o 9 more polyps in proximal colon of variable size and type. frozen sent from two of them..s/o moderate to severe dysplasia in both.

TOTAL abdominal colectomy done with ileo rectal anastomosis and proximal diverting ileostomy. 

HPE: T3, N1, G1 adeno ca  of colon, (1/16 nodes positive), all  11 polyps showed moderate to severe dysplasia.., ALL resection margins are free of tumor. 

pt discharged on POD 10. 

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