Archive for July 2012
A difficult incisional hernia, a TEP repair, a chronic breast abscess and 2 difficult gallbladder empyemas
Posted on: July 19, 2012
16.7.12
An incisional hernia following cesarean section 20 years back in UP. Uterus and bladder adherent to abdominal wall through the hernia. UB got injured and was repaired. A large mesh to repair the defect. Satisfactory recovery.
19.7.12
A bilateral TEP repair in a 65 years old man. Left hernia bigger and direct; the right one indirect and smaller. Bilateral mesh implant.
19.7.12
A young female (30 yrs old) with a breast lump – reported to be tubercular in nature on FNAC. At excision under GA – turned out to be a thickwalled abscess with thick pus inside. The whole wall of the abscess excised and sent for biopsy.
Two difficult empyemas of gallbladder. The first one, preoperatively thought to be easy on US and LFTs, a younger 30 years old female, surprisingly turned out to be tense and turgid, full of pus which was aspirated. The duodenum was densely adherent, but was dissected away. The big stone in the neck came in the way of dissections and so was taken out first. The the cystic duct could be identified but the cystic artery could not and was simply coagulated. The gall bladder had to be cut into 6 pieces to remove because it would not come out thru the 1 cm port.
The second one was not as difficult but turned out to be sessile gallbladder with a previous history of ERCP and ES for duct stones. The gallbladder was simply ligated at the neck with no 1 vicryl.
Intestinal tuberculosis, glomus tumor, wrongly diagnosed cecal cancer, rectal prolapse, neglected torticollis and big incisional hernias.
Posted on: July 18, 2012
10.5.12
A 16 years old girl for laparoscopic appendectomy. Seen to have a terminal ileal mass at laparoscopy. The ileocecal segment was exteriorized laparoscopically, delivered out through a RLQ incision, and REEA was performed. Histopathology reported it to be tuberculosis of intestines.
17.5.12
A 50 years old policeman presented with recurrent discomfort in the left iliac fossa. He said he had visited all doctors around the area and all investigations done to no effect. At diagnostic laparoscopy, he was found to have a long adherent retrocecal appendix, the removal of which resolved the problem and the patient felt very grateful.
A clipless lap chole, the cystic duct sealed with harmonic scalpel in a 50 yr old female.
20.5.12
A small glomus tumor on left index finger excised under GA.
24.5.12
A young 30 years old prisoner, with history of appendix abscess drained in the unit on prisoner duty earlier, presented with a persistent mass in RIF. Was lingering on in the hospital for 4 months. FNAC of the mass showed only inflammatory cells. At operation, a densely adherent mass, adherent with terminal ileal loops, and cecum. All of it was excised and EEA done. Biopsy was reported as adenocarcinoma of cecum.
28.5 12
Dr Rama’s case: A 55 years old female, related to Dr Rama, reported with a thick walled gall bladder, with biliary stent in place at ERCP in Chandigarh for jaundice. Jaundice now relieved. With a thick walled gallbladder on CT and family history of cancer (cancer family syndrome), an open chole was done and cholecystectomy done with a 2 cm wedge of liver tissue. Biopsy however was nonmalignant luckily.
9.6.12
Held a clinical meeting in the ME cell of college. Delivered a talk on ‘The Symbol of medicine- the caduceus vs the staff of Aesculapius’.
14.6.12
A big incisional hernia repaired in a 60 years old female (relative of Fateh Singh, my neighbour). The hernia followed a resection of a big pelvic tumor (neurofibroma) at Patiala surgical center.
22.6.12
Laparotomy for perforation of ileum caused by the umbilical trocar inserted for diagnostic laparoscopy. Perforations closed and peritoneal cavity lavaged.
5.7.12
Five lap choles, 2 of which were clipless, done by harmonic sealing the cystic ducts.
9.7.12
A huge incisional hernia in a 55 years old female following open chole at Nawanshahar (c/o Surinder, Staff nurse in OT). A lot of terminal ileal loops and the whole of ileocecal junction and the right colon outside the abdomen. Difficult mesh repair.
Rectopexy (Wells) for complete rectal prolapse in a 60 years old man.
12.7.12
A bipolar sternocleidomastoid tenotomy for torticollis in a 16 years old female.
TEP repair of a right inguinal hernia in a 20 yr old male. Satisfactory.
Dr Mohinder Singh's blog 