Archive for November 2014
An adult intussusception, a TEP hernia repair converted to open repair and an anomalous Luschka’s duct identified after division
Posted on: November 20, 2014
10.11.14 An anomalous duct of Luschka was identified only after division, at a lap chole in a 55-years old female. The proximal end was sought in the liver bed and clipped (Dr GS Sandhu (senior resident)’s case).
http://https://www.youtube.com/watch?v=m3QrjaPoVQA&feature=youtu.be
13.11.14
A planned LIH repair by TEP approach had to be abandoned and converted to open hernia repair due to a hole in the peritoneum at the time of creation of space, and loss of space thereafter.
20.11.14 An adult intussusception, diagnosed on US and CT, in a 50-years old female, presenting with sub-acute intestinal obstruction of many weeks, was treated by resection of the segment of distal ileum bearing the intussusception. On cut section, it was found to contain a big pedunculated benign-looking tumour arising from the ileum. 
A Spigelian hernia, a meeting with Dr Robert Rutledge and some difficult lap choles etc.
Posted on: November 9, 2014
28.9.14
Attended a CME (by IMA) at Khanna and chaired a session on ‘mini gastric bypass’ by Dr Robert Rutledge.
6.10.14
Some difficult lap choles, in one of which the Rouviere’s sulcus showed a pulsating vessel in its base.
20.10.14
A relaparotomy for a mass in the right colon which had been deemed unresectable by the residents and a proximal ileostomy had been done. At operation, the mass was indeed found to be fixed to the posterior abdominal wall, encasing the ureter which was dissected clear. However, it remained a palliative resection. The ileostomy was taken down and an EEA (Ileocolic) performed. Biopsy was adenocarcinoma. To be referred for chemotherapy.
30.10.14
Incisional hernia at the medial end of a Kocher incision for open cholecystectomy. A 55 years old lady, known to Dr Didar Singh Walia (forensic medicine). Mesh placed in a the preperitoneal space.
3.11.14
A lap chole in a young (25 years old) male, who was admitted with acute cholecystitis. The gall bladder was thick-walled and showed patched of gangrene in the fundus. Difficult dissection of the triangle of Calot.
8.11.14
A Spigelian hernia in a hefty 40 years old patient, weighing over 90 kg. Presented like appendicitis with pain in the right lower quadrant. The CT however made the diagnosis. Through a lower midline laparotomy, the congested ileal loop trapped in the hernial sac was released from the neck of the sac. The sac was excised and a prolene suture repair, reinforced with a patch of mesh between the muscles and the peritoneum, performed.
Dr Mohinder Singh's blog 