Dr Mohinder Singh's blog

26.7.12 A huge duodenal perforation, closed by residents on 20.7.12, releaking. Young male (20 yrs old poor bhaiya). Explored to find a large perforation and posterior wall of duodenum stuck to pancreas. Mobilised with difficulty and duodenal stump closed. Billroth II type resection and GJ done. Duodenal stump blow out on 5th PO day.

2.8.12 diagnostic laparoscopy in a young (25 yrs old) male from Patran with chronic abdominal pain. Patient of dr Parmod Mittal. Endoscopy in 2011 showed some ulcerations in terminal ileum and ileocecal area – so took ATT for a year or so, but abdominal pain still persisting. At laparoscopy, had adhesions from previous open appy in RIF- these were divided. Running of all small bowel showed no stricture. In the left flank, was an omental band, adherent down in the pelvis; this was released.

5.8.12 four lap choles, 3 of which turned out be very difficult. The first one, an old blind lady (60 yrs old)-  While dissecting with hook posteriorly, some bile leak was observed; changed gears to do the fundus first chole and the gallbladder ligated at its neck by no 1 vicryl loop. Drained bile tru the drain. ERCP next day revealed leak from CBD near CD-CBD junction. Stented – the drain dried up in 2 days. The second turned out to be an empyema unexpectedly. Was a younger patient (40 years female) and there was no sign of difficulty preoperatively. But it was a thickwalled empyema. Cut open to remove pus and stones. Ligated at neck. Third one was easy. The fourth againd turned out to be empyema. and same process was repeated.