Dr. Keyur Bhatt - Gastrosurgeon

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

Monday, June 11, 2012

CASE: Unusual case of bowel ischemia^-www.drkeyurbhatt.in*

42 YRS male, non diabetic, non smoker, non Hypertensive
presented with sepsis, shock, ARF (urea 91, Creat 2.1), P: 140, BP: 90/60 On inotrops..drowsy,

( p/h/o: pain in abdomen for 2 days and USG at that time s/o free fluid in abdomen (moderate) with non visulization of appendix / ? perforated appendix...and hence operated for open appendectomy, post op patient did well for 2-3 days , started having fever, distension, pain, low out put on POD 3....AND was referred on POD 7 night )

Abdominal drain was draining dirty , purulant fluid, after adequate rehydration, USG Done s/o dilated aperestaltic bowel loops with multiple pockets of collection through out the abdomen (on aspiration which drained feculant material )

ABG: WAS s/o over compensated alkaline pH.

Was taken up for surgery suspecting stump blow out / cecal perforation with peritonitis

OF SURPRISE: It was TOTAL MESENTERIC ISCHEMIA WITH GANGRENE OF SMA region..with 1.5 liter of toxic fluid in abdomen...unfortunately ...we could not do much for the patient....

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

Thursday, May 31, 2012

CASE: Strange case of abdominal poly trauma^-www.drkeyurbhatt.in*

35 yrs female had high spike of fever, sever pain, agony, distension, shortness of breath, and constipation for 6 days..with swelling (irreducible) in rt flank, tachycardia, and low urine out put..

( Patient had h/o with fall from 4 feet height and sudden onset pain and appearance of swelling in rt flank..
USG: S/O liver laceration/hematoma with mild free fluid, and intermascular colonic hernia
CT SCAN ON day 4:s/o liver tare,hematoma, moderate free fluid perihepatic,para colics, and intermascular hernia of colon
was kept conservatively, with application of abdominal binder..and was discharged on day 6..)

after resuscitation USG/CT was done
s/o gross free fluid and on aspiration it was infected bile.

plan: ERC And stenting followed by surgery (lavage and drainage)

ERC: S/o total loss of biliary tree structure with p/o major CHD/CBD transection, stenting was done

SURGERY: Findings: 1. Trapped interperital hernia in rt hypochondrium with transverse colon
2. 1.5 liter biliary peritonitis
3. liver leceration,hematoma in seg 5,6,
4. TOTAL HILAR SEPARATION WITH 2 CM SEGMENT LOSS OF CHD

procedure : 1. lavage, drainage, reduction of hernia, intarnal mascular interupted absorbable sutures (no mesh) was done.
2. cholecystectomy, hilar exploration identification of ducts, CBD, "T" TUBE insertion from Right duct to CBD-Duodenum, left system 10 fr drainage tube placement, sub and supara hepatic,pelvic, paracolic drains.
3. Feeding jejunostomy

patient recovered and was discharged with SUBHEPATIC DRAIN, BLOCKED T TUBE, open left duct stent, with refeeding of bile via FJ. on POD 16.

Planned for DEFINITIVE HJ After 2 months.

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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: HILAR CHOLANGIO CARCINOMA^-www.drkeyurbhatt.in*

Middle aged male with Surgical obstructive jaundice, with Bilirubin more than 15 mg/dl
MRCP: S/O block in CHD

PLAN: ERC and stenting was done to reduce the bilirubin, Which decreased after 35 days to less than3,
Again CECT with angio done for liver:

SURGERY : Hilar excision, with lymph node dissection was done with RYHJ, (Stented anastomosis on both the side with two ducts on each side with septoplasty )
patient recovered uneventfully post operatively and resection margins were free of tumor and all 10 L.N. were reactive..

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