Dr Mohinder Singh's blog

13.7.07

had to go despite vacation for a lap appy

25M from nabha – c/o nimma’s sister

easy, quick and bloodless operation 

vacation till 14 August:

20.7.07: called to help at laparotomy for intestinal obstruction.

Actually an abdominal cocoon, enclosing all of small bowel except 2 feet of proximal jejunum ; the cocoon was thicker distally and became progressively thinner proximally. All trapped bowel freed by extensive adhesiolysis.

30.7.07

laparotomy 8 years old male child, with mass in right lower abdomen : no intestinal obstruction but had fever off and on.

At operation mass > 10 cm , involving terminal ileum 2 feet proximal to ICJ; diffuse thickening of wall and mesentery and lots of mesenteric nodes. Mass excised and EEA made. Possibly lymphoma

Biopsy report –  NHL

9.7.07

A total thyroidectomy for a Hurthle cell tumor in a 45 years old female ended up badly. At the end of the operation, the patient had a breathing problem, the vocal cords not moving well; was reintubated and sent to ICU. On 9.8.07, was reported to be doing fine after tracheostomy which was done in the ICU, and patient sent home with the tracheostomy tube after a few days when she insisted on going home. The tube was changed for a smaller tube today.

10.7.07

A diagnostic laparoscopy was performed in a young unmarried woman of 20 years of age for pain lower abdomen and a rudimentary uterus on ultrasound. The diagnostic laparoscopy showed uterus as 2 rudimentary horns with a connecting fibrous bar in the middle. Both were excised laparoscopically considering the possibility of presence of endometrial tissue in one or both of them ( patient presenting with occasional pain in the lower abdomen). In view of the uterine and vaginal hypoplasia, the final diagnosis made was – mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).

10.5.07

Sistrunk’s operation for a thyroglossal cyst in a 15 years old.

 

Mandibulectomy (partial):  Right anterior part of the mandible and symphysis menti removed, for tumor involving all this part of the mandible. 20 years of female, mentally retarded with epilepsy and sebaceous adenomas of the face (tuberous sclerosis). After excision, malleable wire was used to stabilize the mandible. Biopsy was reported as sclerosing fibroma.

 

 

14.5.07

Very difficult lap chole. Bile leak postop persisted for 3 days, then dried up.

 

15.5.2007

A 40 years old male heavy alcohol addict (Dr Jagga’s case) had a part of a denture stuck in upper esophagus for nearly 3 weeks now, could not be removed by repeated endoscopic attempts here in Patiala and then in Chandigarh. This was removed through cervical esophagotomy made on the left side.

 

17.5.2007

Ureteroneocystostomy left side for hydronephrosis and hydroureter; 7 years old male child with stricture lower end of ureter.

 

7.6.07

Big ovarian tumor with ascites in a 17 years old female. Cut section showed hair and calcified areas. Biopsy report was benign teratoma.

 

11.6.07

2 lap choles and one lap appy.

 

18.6.07

TEP. clinically direct hernia was actually indirect, difficult dissection, had a pseudorecurrence ?seroma. resolved after 20 days.

 

25.6.07

Called to participate in a nephrectomy R for NFK. Patient in prolonged shock still bleeding from IVC tears and tears of multiple lumbar veins, all sutured but the patient succumbed, having been in prolonged shock!

 

 

2.7.07

TEP

 

 

30.4.07

Six lap choles.

16.4.07

Appendicectomy in a 10 years old male child, s/o dr Tejinder Singh Dhillon our ex-house surgeon, now in Khanna.

2 lap choles.

12.4.07

AH Pyeloplasty in a 10 years old male child with hydronephrosis.

A nephrectomy (R) for a big intrarenal staghorn stone ; the renal hilum bled badly, clamped with vascular clamp and closed over with silk sutures.

Emergency in the evening: cancer rectosigmoid obese 55 F; admitted for more than two weeks in medicine with intestinal obstruction; CT done very late showed nothing but colonoscopy showed the rectosigmoid tumor. An emergency colostomy for obstruction was done by the senior resident (Dr Bharti) two days back but this had retracted and was not working, hence an emergency surgery had been fixed. At operation, an extended right hemicolectomy for a big exophytic tumour in the rectosigmoid with extensive adhesions was performed; the prolonged surgery ended up in a Hartmann’s procedure. However, the patient died on 22nd in the ICU, allegedly of MI.

9.4.07

Another bad colon cancer case: A 50 years old Mr Bahadur had been operated in Malerkotla civil hospital, where the local surgeon (ex PG from this college under Dr Bandlish) did a laparotomy (thru RPM incision!) for perforation of the ileum which was closed; this closure leaked and the patient referred to Rajendra Hospital; our SR reclosed the perforation and found a tumor in the splenic flexure; He did a transverse colostomy.

On exploration by me, dense adhesions were found all around; through a midline laparotomy, an extended right hemicolectomy was performed and an ileosigmoid anastomosis made.

5.4.07

A rectosigmoid cancer in a 50 years old female presented with intestinal obstruction; colostomy 2 weeks back in emergency had been done for obstruction. A sigmoid resection was done today and a colorectal anastomosis performed.

2.4.07

TVGJ for nonhealing ulcer and GOO ; obese 50 M

29.3.07

GJ for GOO: An 80 years old female presented with a short history of gastric outlet obstruction (GOO) and a CT showing a mass (Ca?) in the gall bladder. At operation ,the dense mass in RUQ causing GOO was not disturbed, but a palliative gastrojejunostomy was performed.

26.3.07

5 lap choles one after the other.

22.3.07

APR in a 22 years old male with a low rectal cancer extending into the upper anal canal.

12.3.07

VVF repair in an obese 50 years old from village (hysterectomy at Samana (dr arora) – fistula for last 2 years). The fistula at the dome of the bladder was repaired abdominally.

15.3.07

2 ileostomy closures; both young men with enteric perforations in the terminal ileum – exteriorized  3 months back.

8.2.2007

A branchial cyst was excised in a 15 years old male. The cyst ruptured during excision was was otherwise excised easily. However, an associated piece of cartilage attached to it was an unusual finding.

1. A neat thyroid lobectomy in a 20 years old female for a follicular adenoma. however, the vacuum suction drain pump rapidly filled up with blood – re-explored to find a laceration in the external jugular vein by the drain trocar. The rent was sutured.

2. A 45 years old female with a 2 cm cystic and solid mass in the superolateral part of right breast on mammograhpy, and clinically impalpable axillary nodes. histopathology was unclear. A lumpectomy and SLN bx was planned; methylene blue did stain a node; but had some other enlarged nodes ; so removed all – sort of axillary clearance was done. At final histopathology, no LN came out to be involved. However, the oncologist decided to go ahead with chemotherapy.

15.1.07

1. 35 years old female with an easy gall bladder.

2. 35 years old female with a gall bladder with with a short cystic duct.

25 years old male from Jagraon was diagnosed as appendicitis and appendicectomy done at civil hospital Jagraon. Biopsy of appendix was reported as tuberculosis. Was started on antituberculous therapy. Had taken these drugs for 2 months, but continued to have attacks of intestinal obstruction.

At operation, the caecum was found to be contracted and and terminal ileum tightly strictured 2 strictures proximal to cecum along with other multiple strictures proximally. This 15 cm length of terminal ileum with strictures and cecum were excised and EEA done.