Archive for August 2006
31.8.2006
Unusual parotid:
Parotidectomy in a 50 years old female with small parotid (R) mass 2 cm, reported on FNAC as lymph node within the parotid! Actually at operation, the superficial lobe was found to be normal; the deep lobe had a soft swelling about 2 cm in diameter; aspiration yielded brownish fluid – degeneration? in the cyst. The cyst was enucleated intact from under the branches of the facial nerve – between the two trunks of the nerve. At a higher level in the preauricular area just above the parotid tissue was a lymph node. That too was excised. The suction drain came out during shifting of the patient; small hematoma developed as a result. Biopsy report – cyst parotid ! no malignancy.
LRVH and Staghorn Stone/s
Posted on: August 28, 2006
28.8.2006
Laparoscopic repair of small PUH; the small amount of omentum protruding through the defect was reduced and a mesh 12X12 cm in size was sutured at 4 corners and tacked at 3 more places.
A big staghorn stone (in renal pelvis) along with some small ones (one in upper pole calyx and two in lower pole calyx) were removed via pyelolithotomy in a 60 years old fit rural lady. Easy enjoyable procedure.
20.8.2006
A lap chole started by Dr Vikram and completed by me due to lots of adhesions in Calot’s triangle. This was dissected with difficulty and the procedure completed. However, at the end of the procedure, a hole in the diaphragm was observed (possibly by the slipping of the fundus grasper upwards into the diaphragm). The telescope could be passed through the hole to see partially collapsed lung. A chest tube was inserted and the rent in the diaphragm sutured laparoscopically with 2-0 vicryl.
24/8/06
TEP for left inguinal hernia in a 35 years old male patient. There was no intraperitoneal leak of gas for the first time! There was a big indirect sac; this was cut midway and not endlooped. The mesh was fixed with one tack and the mesh was unrolled in the preperitoneal space. Had retention of urine with overflow on postoperative day 1. Recovered the next day and discharged. On 29.8.06 at follow-up, had a swelling in the inguinoscrotal area and the worried patient was reassured and observed ? hematoma/ seroma/pseudo-recurrence. The swelling disappeared in 3 weeks.
14.8.2006
Nephrectomy in a 50 years old female with a history of right renal pain and persistent UTI – IVP showing non-functioning kidney. At operation the kidney difficult to locate, being abnormal, small and dysmorphic with no well defined vessels and ureter. However , once located, it was easily removed.
Left colectomy in a 55 years old man for a rectosigmoid stricturing carcinoma causing obstruction and for which a proximal transverse colostomy had been done at Tohana a month back (referred by Dr Kanwarjit Singh, anesthesia). At operation, a big tumour was found to be palpable in the whole of upper and middle rectum, adherent with urinary bladder anteriorly. The tumor was mobilised with difficulty and excised along with sigmoid and left colon upto the colostomy in transverse colon to enable an anastomosis of the right colon with the rectal stump. A stapled circular anastomosis was made. Unfortunately the patient had an anastomotic leak, ending up with an ileostomy on 21.8.06 with resuturing of the leaked anastomosis.
Hydatid cyst or pheochromocytoma, cancer of colon in 18 years old, Ileocecal tuberculosis
Posted on: August 8, 2006
July 24, 2006
1. A supposedly hydatid cyst of liver (on investigations, US and CT) – turned out to be a retroperitoneal cystic mass with a well defined capsule. Attempted enucleation resulted in a tear in post wall of the IVC under the liver. Controlled with difficulty using 3/0 prolene on the IVC tear; biopsy reported as pheochromocytoma; Never seen a cystic type of pheochromocytoma so far.
July 27
A closure of colostomy in a 40 years old male (loop colostomy done in April for impalement rectal injury). The colostomy was dismembered and reanastomosed.
July 30
An obese lalaji from Samana with obstructed PUH, recurred after repair at Samana one year back.
The small gut loops were found to be grossly distended and dusky with several patches of discoloration at many places. This recovered after decompression and covering with warm packs. Mesh repair was done thereafter. The postoperative Ileus persisted for 4 days.
July 31
Laparotomy for a large mass in the right lumbar region in a young 18 years old female (c/o Dr Bhagwant Singh). Barium study had shown the colon to be clear and the patient had no bowel symptoms as such. However, at surgery, the big mass looked like arising from the right colon and infiltrating into an adherent loop of upper jejunum. Both the mass and the involved jejunal loop were excised along with the right colon in an extended right hemicolectomy. Posteriorly in the retroperitoneum the mass was adherent with the head of the pancreas, and was shaved off from there. On cut section the large irregular ulcerated mass of colon was found to have invaded into the loop of jejunum too. Biopsy later reported adenocarcinoma of colon. Referred for chemotherapy.
Aug 3
1. Laparotomy (Surjit Kaur: Dr Kaler’s patient): Excised the recurred right ovarian mass, when CA 125 showed a rise last week (previously had a big ovarian tumour excised 2 yeas back, and later had had had chemotherapy for ovarian cancer at AIIMS, Delhi).
2. An ileocecal mass with multiple strictures (TB) and adherent gut loops in the pelvis in a 16 years old female on ATT. All excised with difficulty; ending with an ileocolic anastomosis.
Dr Mohinder Singh's blog 