Dr Mohinder Singh's blog

The cremasteric reflex in the 7 years old boy with right-sided undescended testis was nicely captured in a short video clip by a final year medical student.

15.4.15 Right sided undescended testis, in a 7 years old boy, was found to be impalpable and not shown up on the ultrasound scan. However, on exploration by assistant professor (dr djs walia), was found in the inguinal canal and was fixed in the scrotum after mobilization.

An 11 years old girl with torticollis – the tight band of the fibrosed sternocleidomastoid was released from its sternal and clavicular heads, and also from its mastoid attachment, using the harmonic scalpel. 

18.3.15 A frustrating experience with laparoscopic attempt at removal of a large (>6 cm) adrenal incidentaloma of the right adrenal gland in an obese 40 years old man (c/o dr sandhu, senior resident). Poor unhelpful liver retraction of a large pendulous liver by the absent-minded assistants who would rather injure the liver than retract it strongly upwards, poor camerawork by the other unhelpful assistant who would just fail to concentrate on his job, and poor anaesthesia by the junior residents who would just not accept that the patient needs good relaxation, led eventually to conversion to open procedure at which the tumour was easily removed. the biopsy was reported as benign – myelolipoma.

10.11.14 An anomalous duct of Luschka was identified only after division, at a lap chole in a 55-years old female. The proximal end was sought in the liver bed and clipped (Dr GS Sandhu (senior resident)’s case).

13.11.14

A planned LIH repair by TEP approach had to be abandoned and converted to open hernia repair due to a hole in the peritoneum at the time of creation of space, and loss of space thereafter.

20.11.14 An adult intussusception, diagnosed on US and CT, in a 50-years old female, presenting with sub-acute intestinal obstruction of many weeks, was treated by resection of the segment of distal ileum bearing the intussusception. On cut section, it was found to contain a big pedunculated benign-looking tumour arising from the ileum.

7.9.14

A big renal cell carcinoma (more than 19 cm across) involving the superior pole of left kidney and adherent to spleen and tail of pancreas in a 35 years old female, excised through anterior approach. The pedicle slipped leading to considerable bleeding and panic. The bleeding was controlled with the help of a  vascular clamp and sutures.

16 and 17 august

Attended a urology conference (north zone, urological association of india) along with dr sukhpreet and dr grover. Watched interesting surgeries: laparoscopic partial nephrectomy, laparoscopic radical prostatectomy, RIRS and mini-PCNL etc.

27.8.14

Assisted dr Vikram in a lap chole in which a stone (impacted in the neck of gallbladder and had eroded into the wall of the bile duct – Mirizzi syndrome) had caused transient jaundice last week although the LFTs were normal now. The dislodgment of the stone left a defect in the wall of the bile duct. This defect was covered with a flap of the wall of the gallbladder neck which had been left as a long stump after ligating the gallbladder neck. Bile leaked for 10 days through the drain, then dried up.

28.9.14

Repaired a large laryngocele for the first time in life!. Had never seen it actually before this one. An old man ( a chronic smoker) had been having a large swelling on the right side of the neck for a long time, and now had been experiencing some pain and hoarseness of voice. ENT examination revealed an internal component of the laryngocele too which had displaced the larynx to the left.

6.3.14
A 27 yeas old male, HCV positive, presented with a mass (15 cm across) in the left lower abdomen, and found to have an undescended testis on examination. AFP and HCG grossly elevated. At exploration, the big tumour was found to be adherent to the sigmoid colon, which had to be resected along with the tumour.

An arteriovenous malformation on the forehead in a 22 years old man, previously incompletely excised in Haryana, excised again after ligating the feeding superficial temporal and other small vessels.

A breast lump in a 60 years old female, negative on FNAC and Core needle biopsy, excised widely. Cut section typically scirrhous.

28.11.13

a A mesenteric cyst (diagnosed clinically and on CT) turned out to be big ovarian cyst. easily removed at laparotomy.

An impacted stone in a ureterocele, removed through open cystostomy and meatotomy.

30.11.13

A difficult lap chole, thick-walled gallbladder adherent to live bed which bled furiously, controlled with packing.

16.12.13

A rectal cancer (low) resected and a stapled anastomosis low in the rectum performed.

40 years old male, poor emaciated addict (bhukki) with repeated attacks of subacute intestinal obstruction. At laparoscopy, some adhesions in right iliac fossa, but the real cause of SAIO was multiple strictures in the small bowel about 50 cm proximal to the ileocaecal junction. Some fluid in the pelvis, was sampled for lab studies, especially for tuberculosis.

24.10.13

21.10.13

Radical left nephrectomy for RCC in the middle pole of left kidney. Patient a 45 years old man (c/o worker at dr Sachdeva clinic). Had one episode of haematuria and CT showed the tumour. Anterior approach, removed with perinephric fat intact. No lymph nodes palpable.