Archive for December 2007
17.12.2007: 3 lap choles
Lap chole in a 50 years old female from Ghagga. Easy.
Another lap chole in a 50 years old female from medical ward.
Lap chole and lap appy in a 55 years old female with persistent pain of appendicitis for more than a week and a previous history of attack of biliary pancreatitis (c/o pharmacist in store, Charanjit Singh).
TEP for bilateral inguinal hernias in a 50 years old male, apparently direct, but turned out to be both indirect sacs, right bigger than left. Quite satisfactory dissection at last. Took nearly 1.5 hours.
Chordoma / neurilemmoma – presacral tumour, a splenectomy for a huge spleen, a TEP and IAGES conference, and a fallacy of perception in lap chole
Posted on: December 13, 2007
19.11.07
TEP – RIH direct and indirect. The direct sac appeared as a pseudosac (stretched fascia transversalis) and the indirect one got torn. The dissection should have started higher up.
29.11.07 to 2.12.07
Attended the IAGES conference for fellowship (FIAGES) at Apollo, Delhi. Held by Dr Ajay Kriplani who did a nice demonstration of TAPP hernia repair, a PUH repair (TAPP type) and a splenectomy (had to be converted to open due to uncontrollable excessive bleeding).
Other procedures shown in workshop – Nissen fundoplication, TLH, TEP, lap chole, lap nephrectomy.
3.12.07
Lap chole started by SR but as the anatomy appeared strange, was called for help. The shape of gall bladder fundus appeared like a shrunken gallbladder and the body of gallbladder under it was then mistaken for the duodenum.
6.12.07
Splenectomy for huge spleen causing hypersplenism. 60 years old male with pain, and CT showing a big infarct in a huge spleen.
Difficult procedure due to adhesions with diaphragm and colonic flexure.
8.12.07
Went to Ludhiana to attend a meeting called by Dr Kuldeep Singh of DMC for arrangements for the forthcoming ASICON at PAU Ludhiana
13.12.07
Wrong diagnosis of an ovarian cyst 25F.
Actually a chronic ruptured ectopic pregnancy ; reported on US as cyst.
Presacral tumour – possibly a chordoma- eroding the sacral ala on right side. Removal led to severe bleeding from avulsed vessels in the presacral space and tear in the iliac veins which were stretched over it (the internal iliac artery had been already controlled). Very difficult to control ; Pt remained in persistent hypotension. Eventually the external iliac artery was retracted laterally after ligating some of its branches so as to expose a tear in the internal iliac vein under it, the small hole was controlled with a single stitch of 5-0 prolene. Some other venous bleeders from some unidentified veins in the cavity after removing the tumour were also ligated and the wound packed with several (5) lengths of roller gauze. Even then it took some time (nearly an hour in ICU) for the BP to come up to 100. Thereafter she gradually recovered.
Biopsy: neurilemmoma.
Dr Mohinder Singh's blog 