18.10.20

An interesting encounter with gall stone disease: A 55 years old female (mother of Neetu, worker in OT of Shalley hospital), obese and diabetic and hypertensive was known to be carrying gall stones for many years. She landed up in septic shock (cholangitis) and severe pancreatitis and jaundice. Was luckily resuscitated and survived. An urgent ERCP (dr Atul) and stone extraction and stenting the bile duct followed. She reported passing her stent per rectum about 3 weeks later. Luckily the subsequent lap chole was not very difficult.

28.11.20

Another lesson in lap chole: an apparently easy lap chole (as per dr Jagga’s opinion) in a 55 years old female turned out to one of the most difficult and took more than 3 hours. First of all, the duodenum was adherent high up to the fundus which was very thick walled. This was carefully dissected safely. Next the cystic duct was thick walled and friable and the vicryl ligature cut through. Luckily the stump then could be clipped with two large clips. Thirdly, when beginning the dissection of the gall bladder it appeared as if the infundibulum was actually below where the cystic duct had been clipped. But by careful further dissection a safe plane behind the gall bladder could be created and what looked like the infundibulum was actually an large cystic lymph node (fallacy of perception).