Dr Mohinder Singh's blog

 4.9.07

Femoral hernia after a long time. An old lady 65 years of age presented with obstructed hernia; at operation, the obstructed loop of ileum was found to be dusky in colour but recovered. A Low repair (Lockwood) was performed; only sutures, no mesh. The postoperative Ileus persisted for 4 days

6.9.07

Lap chole, an expectedly easy one, became difficult. A 35 years old rural male patient; thick walled GB; wide neck and cystic duct endlooped twice with vicryl. Drained. Next morning had severe upper abdominal pain, and distension and fever with TLC 17900. LFTs normal. US normal. X-ray no free air, but distended colon and minimal bilateral pleural effusion. Became rapidly normal by 2nd and 3rd postoperative day. Discharged on 4th POD. What happened? possibly  ?? pancreatitis.

13.9.07

Another femoral hernia in a 70 years old asthmatic lady from Rajpura. Another low operation (Lockwood) was performed. Contents only omentum, easily reduced; small onlay mesh to bolster sutures.

       

 

30.8.07

MRM for a 3X2 cm ca invasive ductal

pt preference

1. routine looking lap chole; 50F from MKH (had kidney stones too)

dissection immediatiely presented a clear cystic artery right in front of the camera and seen nicely dividing into 2 branches. After clipping it, dissection under could not define the junctional anatomy; looked like a wide duct or neck and so a sessile gall bladder. This neck was ligated with vicryl and divided. While dividing a lot of stones present in it aroused second thoughts of a lower lying cystic artery which was found later after some further dissection.

2. horrible empyema with thick walled gall bladder. took more than 2 hours and left the posterior wall of gall bladder intact and cauterised it 

transverse loop colostomy done 3 months back  (for a faecal fistula after TAH at Malerkotla; found at exploration to have leak from injured sigmoid and extensive faecal soiling); splenocolic ligament high and in the pelvis sigmoid colon had extensive adhesions); took nearly 3 hours. In the end a satisfactory colorectal anastomosis  

21.8.07  –  35 thin female, with h/o previous TAH at which time a mass in sigmoid was palpable; had no bowel symptoms then

at operation palpable mass in sigmoid excised with 10 cm proximal and 5 cm distal margins and EEA colorectal constructed manually

cut section of specimen showed an ulcerating lesions involving all circumference 

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