Dr Mohinder Singh's blog

3.8.22

A 4 years old male child with clinical features of appendicitis was found to have a big pelvic appendix with two big fecoliths in the lumen; the bigger one near the tip and causing a palpable mass adherent with the right superolateral wall of the urinary bladder. The incision had to be extended medially to locate the appendix and carefully separate the mass at its tip from the bladder.

15.7.22

A poor man (rehriwallah), 50 years old, had a non-healing ulcer on the left angle of the mouth. He had been a zarda addict for decades. Biopsy revealed a squamous cell carcinoma.

Difficulties encountered:

big gall bladders and big Hartmann pouches in those done on 8,9,10,24 june, and on 2, 4, 7 july:

Most had to be aspirated to make them smaller, some opened up to empty them of all stones. The big Hartmann pouches had to be carefully lifted up and dissected slowly.

The one done on 8.6.22 had a band like vessel causing pressure on the H pouch. On division of the band with vessel (cystic artery) in it, the pouch became one with the gallbladder. Thereafter, the cystic duct was found to be non-existent, and gallbladder was deemed to be sessile; hence endo-ligated at the neck and divided and removed.

3.7.22

A most difficult lap chole; entirely unexpected from reports. A 50 years old male police inspector. Lap chole had to be converted to open after finding that the adhesions with duodenum were inseparable and that further efforts might end up in a duodenal leak. At open operation, blunt finger dissection opened up an empyema which was cleaned up. The big stone in the neck of gallbladder was removed. Rather than attempting to separate the gallbladder from the duodenum, some wall of the gallbladder was left with the duodenum and the remaining walls of the gallbladder were removed, thus leaving behind the frozen Calot’s triangle as such. The fossa from where the stone was removed revealed a small bile leak, presumably from the pressure of the big stone causing some erosion of the bile duct, and a drain was kept. It drained small amounts of bile till 27th of July and then dried up.