Dr Mohinder Singh's blog

20.11.09

Laparoscopic excision of a big paratubal cyst (6 cm). Rather than the cyst alone, the whole mass of the cyst, tube and ovary was excised at the request of the attending gynaecologist. The other tube also coagulated with bipolar diathermy and cut (patient’s demand).

 

23.11.09 

Carcinoid ileum – Right hemicolectomy for a presumed cancer caecum. A big mass palpable in RLQ of abdomen in a 20 years old female!. Getting obstructed with solid feeds, so kept on liquids for some days. CT showed mass in the caecum and ascending colon. Cut section showed mass in wall of terminal ileum rather than the lumen of caecum. Turned out to be carcinoid on histopathology and immunohistochemistry.

5.11.09

1. Big hydatid cyst right lobe of liver pressing on gall bladder and bile ducts, leading to elevated bilirubin levels. Laminated membrane excised in toto in one piece, and cavity partly obliterated (capitonage) and then filled with omentum. No drain.

 

2. Laparotomy for a mass lower abdomen and a vesicoenteric fistula, presumed to be  a desmoid of abdominal wall. 17 M emaciated with history of blunt abdominal trauma, followed by history of urine contamination with faeces. At laparotomy, dense mass in lower abdomen with underlying loops of bowel adherent with it. Opened accidentally (and repaired) the transverse colon loop here while opening the abdomen. Painstaking dissection identified the proximal small bowel loops but the distal ileum, converted into a mass which was adherent to the bladder, had to be excised and EEA done. The bladder fistula was a small one and was closed.

 

8.11.09

30M taken up for appendicectomy thru small RLQ incision had to be converted into upper midline laparotomy on finding turbulent fluid in the peritoneal cavity. A  DU  perforation closed.

 

12.11.09

Two difficult lap choles:

1. Tripat Chand 72 years old male from Barnala (referred by Dr Surinder Garg and also known to Dr Avinash Gupta, AP orthopedics). Had a mass covered with omentum as if it was covering the gall bladder but on some dissection, a non-adherent gall bladder could be visualised behind this mass. Routine cholecystectomy was done with some difficulty due to the mass coming in the way. The mass (possibly with transverse colon or distal stomach)  to be investigated later with CT and other investigations.

2. Post pancreatitis (gallstone) lap chole. 35F. Thick walled cystic duct, endlooped and ligated.

 

16.11.09

Laparoscopic ureterostomy (Dr Sukhpreet’s case) for a presumed stricture or radiolucent stone right midureter in a 30 years old female with pain and right hydronephrosis and hydroureter ureter above the stricture. Transperitoneal laparoscopic approach easily identified the bulge in the right ureter just below the caecum and over the pelvic brim. Peritoneum over it opened and ureter opened longitudinally over it with hook cautery to reveal the curled up stent in it but no stone. The thick wall of the stricture was further opened up and the stent pushed up into the renal pelvis. Uterer closed over it with 3-0 vicryl and the peritoneum too was closed over it.

 

17.11.09

A most difficult lap chole. 65 F obese patient. Tense empyema aspirated to begin with. The neck of gall bladder found to be very firm as if it contained a hard impacted stone in it. This neck was opened up to find a very thick walled abscess here. Dissecting below this could have been dangerous, so fundus first dissection was done upto this point and a subtotal chole was done. Three big stones removed from within the opened up gall bladder. These were broken into pieces and removed piecemeal. Then the gall bladder walls were also cut into several pieces and removed . Drained. 

 

18.11.09

A difficult TAHBSOP. 40 F with previous unsuccessful attempt at Sirhind. The problem was the big fibroid with posterior wall of uterus. This was stuck in the pouch of Douglas, and pressing upon the displacing the right ureter.