case: malrotation with obstruction and gangrene...in a case of Nephrotic syndrome^-www.drkeyurbhatt.in*

young male k/c/o nephrotic syndrome on steroids..presented with acute intestinal obstruction with distension....conservative trial failed to manage...taken up for surgery:

previously operated by pediatric surgeon at the age of 3 days for malrotation with obstruction.

SURGERY: Extremely difficult laparotomy more than 7 hrs with dilated gangrenous bowel loops densely adherant...total 3.5  feets of gangrenous ileum was resected...and jejuno ileal anastomosis done single layer interupted...

fortunately healed on low albumin and on steroid with gangrene...and patient discharged home after 10 days...

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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 - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

CASE : SMA Thrombosis with ischemia^-www.drkeyurbhatt.in*

Young male presented with acute abdominal pain severe in intensity with vomiting and distension, work up s/o acute thrombosis in SMA with more than 90% blcok in CT Angio

CECT:

 Was kept conservatively and started on IV heparin..and gradually discharged over 5-6 days on oral anticoagulants and full diet.  was kept under close follow up as likely to develop stricture in coming 4-6 weeks

and rightly happened...presented with bilious vomiting after  6 weeks....was admitted and evaluated...found to have stricture in jejunum with dilated proximal bowel loops.... but by that time artery was totally recanalised...

surgery was done and discharged without any undue complication in 5 days..

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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 - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

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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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 - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

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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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 - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

 

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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www.gisurgerysurat.com/

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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 - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon