Dr Mohinder Singh's blog

16.3.20

A 12 years old male child was operated in the left groin on the suspected diagnosis of a hematoma (history of trauma and diagnosed on ultrasound). Actually turned out to have a nice encysted hydrocele of the cord which was excised, after disconnecting its connection with the processus vaginalis. Dr Jagbir’s case.

15.11.19

A 50 years old male presumably with a popliteal cyst in the left popliteal fossa turned out to have a neurofibroma actually.

A big lipoma of the thigh resected at GSMCH in a 55 years old man.

3.12.20

A spigelian hernia in the left lower abdomen just above the previously repaired inguinal hernia, repaired with mesh – the patient a 70 years old man Narinderpal singh. Previously operated also for similar right sided spigelian hernia by me some 7 or 8 years back, that side also having had a previous inguinal hernia repaired more than 20 years back. Thus this unfortunate man had 4 lower abdominal and inguinal hernias all of which had to be repaired.

27.1.20

An MRM of the left breast was performed for multicentric lobular carcinoma in a 45 years old female. Dr Jagbir’s case.

17.8.19

A routine lap chole in a 55 years old female turned out to be unexpedtedly difficult, resulting in considerable bleeding from the liver bed. This was controlled with cautery and pressure with gauze, and several pieces of gelfoam were later pressed into the area. Discharged the next day, had to be readmitted on 19.8.19 with abdominal distension. Treated as ileus with IV fluids and recovered by 21.8.19.

2.9.19

Another lap chole case had to be readmitted on 4th PO day for severe abdominal pain, possibly pancreatitis. resolved with conservative treatment in 2 days.

23.9.19

Another lap chole landing up in trouble. A young 30 years old male underwent a very difficult lap chole due to the frozen Calot’s triangle and a very thick walled gall bladder. Postoperatively had a bile leak which was 200 cc on the first postoperative day and then continued to decrease in amount gradually drying up in 18 days. MRCP shown below reported a small collection and a ? kink and narrowing at the site of cystic duct-CBD junction. Was it a cystic duct blow-out?

24.9.19

Cystogastrostomy and cholecystectomy in a 65 years old female who was admitted more than 2 months back in ICU for severe pancreatitis. Had developed a big pseudocyst which continued to persist and cause pressure symptoms.

A lot of necrotic debris was also removed from the depth of the pseudocyst cavity.

9.10.19

An attempted lap chole in an 85 years old man (Dr NP Singh’s case) was abandoned, due to dense adhesions and the liver being very hard and cirrhotic with innumerable nodules on its surface.

13.4.19

An atypical Fournier’s gangrene had resulted in perianal sepsis. The patient, a 50 years old male, first presented with pain and tenderness in the scrotum. There was a palpable crepitus in the scrotum – pneumoscrotum. CT scan showed a lot of gas in the scrotum.

The patient was treated with antibiotics and the pneumoscrotum gradually resolved but the patient developed a soft urethral stricture which was dilated.

Also he developed a perianal abscess which was drained. However, this eventually ended up in a complex horse-shoe fistula which was excised.

22.4.19

A supposed hydrocelectomy had to be converted into orchiectomy. Dr jagbir’s case. Hard testicular tumor with necrotic areas.

6.6.19

Called for strangulated right inguinal hernia in a 70 years old male Dr Vikram’s case). REEA of about 6 inches length of gangrenous ileum had to be done.

21.6.19

A huge recurred dermatofibrosarcoma of the left thigh in an elderly female was excised followed by skin grafting of the defect.

25.6.19

Sacrocolpopexy for vault prolapse. Previously had laparoscopic hysterectomy 20 years back at Doraha. (Dr Arora’s case).

26.6.19

Nephrectomy for non-functioning left kidney (due to stones of many decades standing) in a 68 years old female from himachal pradesh.

18.7.19

Sigmoid colon cancer resected with colorectal anastomosis. the adherent ileal loops as well as the adherent part of anterior abdominal wall excised too along with the colon cancer. A colorectal anastomosis and an ileo-ileal anastomosis had be made.

19.7.19

Laparotomy for recurrent episodes of small bowel obstruction in a 58 years old man. At operation, a stricturing tumour of the ileum was found. This was excised and EEA performed. Biopsy report was GIST.

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.