Dr Mohinder Singh's blog

5.4.13
30 years old female, thought to have pain right lower abdomen because of a TO mass (on US), turned out to have no such mass, but a stump of appendix (left after previous open surgery) – removed laparoscopically.
11.4.13
A large branchial cyst in a 15 years old girl, excised. Contents purulent, hence the pain and sudden enlargement recently.
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Laparotomy for a solid mass in 12 years old boy – turned out to have a solid big mass from mesentery, attached to ileum, which had to be resected along with the mass. The biopsy report was mesenteric fibromatosis.

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Case Reports in Surgery
Volume 2013 (2013), Article ID 569578, 3 pages
http://dx.doi.org/10.1155/2013/569578

Mesenteric Fibromatosis Presenting as a Diagnostic Dilemma: A Rare Differential Diagnosis of Right Iliac Fossa Mass in an Eleven Year Old—A Rare Case Report

Abhinav Mahajan, Mohinder Singh, Anoop Varma, Gunjeet Singh Sandhu, Malwinder Singh, and Rupesh Nagori

22.4.13
Femoral hernia, strangulated, in a 70 years old female. Could not be reduced through lower incision. A lower midline laparotomy added, loop of strangulated terminal ileum released, and an end to end anastomosis made after resection. Hernia repaired from below with ethilon 1-0 interruptted sutures.

15.1.13

A lap chole in a 60 years old man with empyema tested skills. GB cut open and removed in pieces after removing the stones. The gallbladder ligated at its neck without identifying the cystic duct which could not be identified. The neck ligated again with preformed catgut loop (ethicon), but leaked bile for some days through the drain, eventually drying up.

28.1.13

MRM of mother-in-law’s cancer (medullary) of breast. L nodes reported negative.

4.2.13

Abdominoperineal resection for an anal canal cancer which did not respond to Nigro’s chemoradiation therapy. 60 years old man. The perineal wound had apparently healed nicely when he was discharged after 25 days. However,  a week later, the perineal wound gaped (previous radiotheray, delayed healing?), and was resutured.

5.2.13

GB agenesis in a 25 years old male (bhukki addict) presenting with pain upper abdomen and US reporting gallbladder stones. No gallbladder could be found, after removing adhesions of omentum and colon mesentery in the gallbladder fossa.

11.2.13

Vasovasostomy in a 50 y o man who wanted to have children again.

18.2.13

Open CBD exploration in a 50 y o female (relative of dr Rama, my classfellow) for a big calculus (primary) in the CBD .Had an earlier endoscopic papillotomy but the stone could not be removed, and a stent had been placec. Today, a single big stone removed from CBD. No stone was found  in the gallbladder removed.

A huge neurofibroma, a part of von Recklinghausen’s NF, excised from the back of a 25 years old lady.

25.10.12

Re-exploration laparotomy for an obstructed gastric outlet, after laparotomy 3 weeks earlier by residents, in a young (20) male, with transection of duodenojejunal junction following trauma in a RTA. After the duodenal continuity was restored with a sutured anastomosis, a GJ had been added!. The patient continued to have more than 500 ml of bilious NG aspirate, and on removing the tube once, had some bilious leak from the abdominal wound, suggesting anastomotic leak, so the tube was put back in. At operation, the the DJ anastomosis was found to be strictured, and was dilated through an enterotomy with foley balloon and metal dilators, and the GJ was converted to RYGJ.

1.11.12

At lap chole, measured the dimensions of a Rouviere’s sulcus with the help of a feeding tube marked in centimeters, as a part of studying the anatomy of Rouviere’s sulcus as seen during laparoscopic cholecystectomy.

NCASICON at jalandhar – attended for two days : 8 and 9 september. Saw dr Chanjiv and others there.

13.9.12

Open prostatectomy for a huge (150 g) prostate who presented with hematuria. Postoperatively, developed clot retention, and had to be reopened.

Undescended testis in a 2 years old child- no testis found – anorchia.

20.9.12

Closure of ileostomy for a patient of Crohn’s disease who had presented with obstruction and residents excised a segment of ileum and had done an ileostomy. Patient on azathioprine by GE.

Revision of GJ into Roux loope GJ. An older patient who had presented in 2006 with GOO and had TVGJ performed. Now continued to have pain and vomiting intermittently. At operation, had stenosis of both limbs of GJ, which was revised into Roux-en-Y GJ. Did well thereafter.

21, 22 sept

attended SELSI hernia conference at Gwalior along with Dr Sushil Mittal and his team.

28.9.12

Abdominoplasty (assisted dr GP singh) for huge abdominal apron hanging down in a 45 years old female. Persisted with seromas for a long time.

3.10.12

dr Khushpreet’s case – laparoscopic excision of right ovarian cystic mass and left hydrosalpinx.

4.10.12

TEP repair of LIH in a 30 years old male.

11.10.12

TEP repair bilateral hernias 70 years old male. Had seromas both sides postop.

15.10.12

Mahesh Kumar, obese 50 male, admitted with severe pain in OPD. Very difficult lap chole due to obesity, gangrene of fundus of gallbladder, and thick walls making grasping impossible. Calots anatomy not clear. Ligated at lower part of gallbladder and then the suture used to retract the gallbladder further, then Calots defined. Took 4 hours.

22.10.12

Parotidectomy superficial for parotid duct stone and chronic sialadenitis, and stone not palpable intraorally.

9.8.12

Two clipless lap choles – the cystic duct and artery sealed with harmonic scalpel.

20.8.12

An abdominoplasty – assisted Dr GP Singh, the plastic surgeon. Dr Jagga’s patient – a young (25) female, who got a huge divarication of recti after delivery of her baby. The recti were plicated with 3 layers of vicryl.

30.8.12

Two TEP repairs for RIH – both easy and enjoyable.

3.9.12

Thyroid lobectomy (right) for a deep seated nodule of right lobe. 55 years old female (c/o dr BL Bhardwaj). Hoarseness of voice persisted.

Prostatectomy (freyer) for a 120 grams huge prostate – easily shelled out – in a 60 years old. Haemostasis secured with sutures.

26.7.12 A huge duodenal perforation, closed by residents on 20.7.12, releaking. Young male (20 yrs old poor bhaiya). Explored to find a large perforation and posterior wall of duodenum stuck to pancreas. Mobilised with difficulty and duodenal stump closed. Billroth II type resection and GJ done. Duodenal stump blow out on 5th PO day.

2.8.12 diagnostic laparoscopy in a young (25 yrs old) male from Patran with chronic abdominal pain. Patient of dr Parmod Mittal. Endoscopy in 2011 showed some ulcerations in terminal ileum and ileocecal area – so took ATT for a year or so, but abdominal pain still persisting. At laparoscopy, had adhesions from previous open appy in RIF- these were divided. Running of all small bowel showed no stricture. In the left flank, was an omental band, adherent down in the pelvis; this was released.

5.8.12 four lap choles, 3 of which turned out be very difficult. The first one, an old blind lady (60 yrs old)-  While dissecting with hook posteriorly, some bile leak was observed; changed gears to do the fundus first chole and the gallbladder ligated at its neck by no 1 vicryl loop. Drained bile tru the drain. ERCP next day revealed leak from CBD near CD-CBD junction. Stented – the drain dried up in 2 days. The second turned out to be an empyema unexpectedly. Was a younger patient (40 years female) and there was no sign of difficulty preoperatively. But it was a thickwalled empyema. Cut open to remove pus and stones. Ligated at neck. Third one was easy. The fourth againd turned out to be empyema. and same process was repeated.