Dr Mohinder Singh's blog

8.4.19

A hefty tall 55 years old with opium addiction and depression (on treatment with anti-depressants) was hospitalized with acute abdomen and was found to have acute cholecystitis and a big distended thick walled gallbladder with a huge stone (around 5 cm) in it. He also had fecal impaction which was treated with enemas. Laparoscopic cholecystectomy was not considered and an open operation was planned. Even then, the big empyema and the difficult dissection of the Calot’s triangle took more than 2 hours.

Photos clicked by Dr Jasleen.

13.4.19

A similarly hefty and tall male patient, also an opium addict, underwent a similarly difficult procedure. However, the gall bladder and the stone were not so big and so the laparoscopic cholecystectomy was comparatively an easier option. Also, this patient was not depressed and psychotic like the previous patient  and so was not difficult to manage postoperatively.

6.4.19

A young fit man (had been obese and now into fitness programme) with big bilateral gynecomastia. Excised like bilateral mastectomy under GA.

27.3.19

A Nissen fundoplication was done in a 55 years old obese female in an open manner because of the lack of liver retractor.

1.4.19

A 62 years old lady had a long-standing swelling over the right shoulder. MRI showed some adhesions with the upper end of the humerus. Was excised in toto. Biopsy report was hamartoma.

6.3.19

A young man (26 years old) had an appendix mass about 2 months back and was posted for lap appy. At operation there were still some adhesions with the anterior abdominal wall. One such band of adhesions, and an appendix epiploicae together were misinterpreted to be the appendix and so were removed. Later when the caecum was turned a little medially, the real appendix showed up from below and was removed too.!

6.1.19

An obese (>100 kg) lady, related to Dr Mrs Shalley, with a previous lap ventral hernia repair with a prolene mesh, needed a careful umbilical port entry under vision through a small scope brought in through Palmer’s point.

15.1.19

A young (35 years old) female, thought to have an easy lap chole, turned out to be a disaster, with the very shrunken gall bladder with a small stone in the fundus (which was possibly the whole gall bladder on retrospective analysis) having such dense fibrotic adhesions with the underlying bile duct so as to make them to look like a single structure. So the dissection was continued down for a couple of centimeters and the supposed neck of gallbladder ligated there. Bile continued to pour through the drain and the patient had to undergo a BDI repair in PGI.

Lesson learnt – in non-distended gall bladders on ultrasound, always have an MRCP roadmap before attempting surgery.

5.1.19

MRM for breast cancer, with PET scan showing axillary mets. 45 years old, c/o dr Jasleen.