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....

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Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

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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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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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Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

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CASE: Chronic idiopathic pancreatitis^-www.drkeyurbhatt.in*

Middle aged male with pain in abdomen central, with back radiation, for 4 yrs and wt loss and anorexia for 2-3 yrs

Evaluated and found to have Chronic calcific pancreatitis with dilated ducatal system and multiple stones.

CECT: small pseudocyst in head of pancreas with multiples stones in MPD / dilated MPD. S/o chronic calcific pancreatitis


SURGERY: LPJ

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CASE: Massive lower GI bleed in CRF, Stercoral ulcers^-www.drkeyurbhatt.in*

Middle aged male with DM, HTN, CRF, on dialysis
had massive LOWER GI bleed,
h/o chronic constipation present.

COLONOSCOPY s/o large stercoral ulcers in entire rectum with profuse continues bleeding..and active spurting..

multiple sessions of endoscopy was done..over 3-4 days period., with more than 2 transfusion requirement of PCV per day..with all local, systemic measures applied, but bleeding was not controlled

Ultimately patient was taken up for rescue surgery: APR, With permanent colostomy.

pt recovered well in post op period and was discharged in due time..

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