Dr Mohinder Singh's blog

12.12.08

Rectovaginal fistula arising as a result of prolonged labour (home conducted delivery by dai) . Easily approached from below (vaginally) and easily repaired. Patient from some outside town.

16.12.08

In a busy lap day, had the horror of seeing the so-called safety trocar (used for the umbilical camera port entry) causing intraperitoneal bleeding, shock (sudden unrecordable BP) and a big retroperitoneal haematoma seen in front of the scope on introduction of the telescope. Immediately converted and the rent in the aorta controlled with finger pressure and then sutured with 3-0 prolene. Continued to do open cholecystectomy with the courageous anesthetist’s consent. Needed 2 units of BT immediately for resuscitation and 2 more in the ward later.

 Good quick recovery afterwards, although the patient was left with a long laparotomy incision.

25.11.08

TEP thought to be easy, turned out to be a real pain in the neck. Initial space created nicely, but the sac was big and  omentune in it adherent to sac , adhesions had to be divided after opening the sac. this led to loss of space and so struggled thereafter for a long time, what with the anaesthetist not helping also. Mesh spread also not satisfactory.

 

28.11.08

closed a transverse colostomy done in some other unit for unknown reasons. 55F with extensive adhesions between small gut loops with one another and with abdominal wall, the ileum got injured at 3 places in the process of liberating the small bowel, all three perforations closed and the colostomy closed.

 

3.12.08

attempted TAH had to be abandoned as soon as the abdomen was opened and intestines packed up. Patient in cardiorespiratroy arrest; revived with immediate intubation and CPR, kept in ICU till evening. ?spinal shock, anaesthetist not very vigilant.

 

7.12.08

a patient posted for AHpyeloplasty had a close save from the surgeon’s knife on the kidney. On looking at IVP, a questionable grade I hydronephrosis, history: no pain in lumbar area, ?haematuria, US reporting prostatic calculi. History more suggestive of RIF pain , so appendicectomy done instead.