Sunday, April 22, 2012

CASE: Strange case of duodenal third part perforation - close loop obstruction^-www.drkeyurbhatt.in*

22 yrs male with h/o corrosive ingestion 3 months back
with residual gastric and esophagial scaring

FJ was done for the same 3 months back..

patient presented with sever agonizing pain in abdomen for last 2 days with shock

P: 170/min BP: 70 systolic
resuscitation and
CT SCAN S/O : Retro peritoneal collection with free gas..and dilated duodenum and proximal jejunum till FJ site..distal loops collapsed   ? duodenal perforation




exploration: reveled the same a large perforation in D 3 Bellow the vessels with retroperitoneal sepsis.

primary closure , detwisting of jejunal loop , and a new feeding jejunostomy and drainage was done.



Fortunately pt survived..

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Saturday, April 21, 2012

CASE: Chronic alcoholic pancreatitis with pseudocyst in head^-www.drkeyurbhatt.in*

Middle aged male with severe pain in central abdominal pain severe in intensity ,  for 6 months and 25 kg wt loss. DM II For last 6 months..

evaluated and diagnosed as Chronic alcoholic calcific pancreatitis with pseudo cyst in uncinate process of pancreas..

CECT:



SURGERY: LPJ With head coring...




Patient discharged on POD 6. without pain.

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Sunday, April 15, 2012

CASE: Multiple liver hydatidosis with biliary communication^-www.drkeyurbhatt.in*

Young boy with dull aching  pain in RHC region
CECT:; S/O multiple total three, one in seg 6, in seg4b, seg7. hydatid cysts with surrounding biliary radical dilation

PLAN: Pre op ERCP and stenting done

surgery for hydatid cysts 1 week later.

CYSTS Drainage and partial cysto pericystectomy done...post op pt developed bile leak .But due to stenting leak healed in few days and pt was discharged on pod 8.



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CASE: A surgery for chronic diarrhoea^-www.drkeyurbhatt.in*

old  age male with DM , HTN, IHD,
presented with h/o diarrhoea for more than 6 months..

rest all the work up was normal except two large diverticula in jejunam. which was detected since 2002.. but was asymptomatic...

CECT: S/O Two diverticula in jejunum  and Rt lower pole of kidney RCC (coincidentally detected)

Pt is allergic to Metronidazole and lots of other medicines..
all antibiotic trials were given along with probiotics as well with diatery messurement to reduce the diarrhoea...
which failed ultimately taken up for surgery.....and resection anastomosis was done....Along with partial nephrectomy by Urosurgeon...



post op he is relieved from his troubles....and doing great..

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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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