Adrenal indicentaloma
Posted on: March 18, 2015
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.
Adhesive intestinal obstruction, a lap chole using harmonic scalpel, a twisted big fibroid misdiagnosed as appendicitis, and a pulsatile vessel seen in the floor of the Rouviere sulcus
Posted on: March 11, 2015
14.2.15
An elderly female (70 years old) admitted with intestinal obstruction (previous history of 2 caesarean sections) kept on conservative treatment but did not respond in about a week’s time. At laparotomy, a jumbled up mass of some 6 inches of ileum containing a tight stricture had to be excised, and an EEA made.
23 and 24.2.15
PG class on CRC and seminar on faecal fistula on consecutive days.
28.2.15
A lap chole for acute cholecystitis using Harmonic scalpel (for thesis) throughout the dissection, helped in saving time and blood loss. Also made the operation easy by reducing the smoke compared with cautery.
4.3.15
Bilateral TEP repair for inguinal herniae in 40 years old mess servant.
A planned appendicectomy in a 60 years old female actually turned out to be a big twisted fibroid revealed at diagnostic laparoscopy. Converted to open to remove the big fibroid, the pedicle of which had taken three turns.
11.3.15
Lap chole following pancreatitis. Turned out to be quite difficult with a big Hartmann pouch hanging much below the level of the Rouviere’s sulcus. The notable feature of the sulcus was a visible pulsating vessel in its floor.
A thyroid cancer, a few TEP hernia repairs and a few wrongly diagnosed cases
Posted on: February 7, 2015
27.11.14
TEP repair of right inguinal hernia performed on a 70-year-old man referred from Khanna by Dr Bhasin. Needed to have a urethral meatotomy and bladder catheterization also for narrow meatus associated with a glandular hypospadias.
1.12.14
TEP repair of right inguinal hernia in a young 20-year-old resulted in a pneumothorax and collapse of left lung. Kept in ICU for a few days after chest intubation for expansion of the lung.
10.12.14
A big sliding hernia (right inguinal) in a 60-year-old, contained cecum, appendix and omentum, repaired with a mesh.
29.12.14
MRM for a multicentric tumor in right breast in a 76-year-old lady (mother of dr Vinod, ex resident) from Sangrur.
Laparoscopic orchiectomy for undescended testis in a 20-year-old male.
TEP repair of bilateral inguinal herniae, 45-y-old male, worker in the hostel mess.
6.1.15
A very difficult open CBD exploration (55-year-old female) after a previous failed attempt at cholecystectomy at some civil hospital. Dense adhesions all around the shrunken gallbladder, eventually the GB and CBD were identified, a cholecystectomy was performed, a big stone found and removed from the bile duct and a T-tube inserted.
A wrongly diagnosed appendicitis (burst with diffuse peritonitis) in a very sick toxic patient (60-year-old female) actually turned out to be a caecal perforation due to a palpable tumour in the cecum. A right hemicolectomy was performed and the ileum and colon exteriorized after thorough peritoneal lavage. The patient stayed in ICU for 4 days and then recovered.
21.1.15
A hemorrhoidectomy (70-year-old female wit big prolapsed piles, mother of Dr Girish Sahni, ortho) performed with harmonic scalpel turned out to be neat and bloodless.
24.1.15
An anal fistula, diagnosed wrongly as a sinus only because its inner opening was not demonstrated clinically and even on a sinography and MRCP, was found to he a fistula, the whole tract of which was excised. The patient a government servant, 45-year-old male and a diabetic.
31.1.15
Two TEP repairs with harmonic scalpel very satisfactory and bloodless, one had a thin sac and the other a thick sac, both sacs ligated with an endo-loop and excised.
2.2.15
At lap chole, a RHD or the CHD was already found to be injured (small hole) by the diathermy hook before I reached the scene. Dissection completed by me and a drain left in the sub-hepatic space.
4.2.15
A difficult lap chole , started by dr Walia (A P), had to e completed by me.
5.2.15
An 11-year-old child (dr Jagga’s case), diagnosed wrongly with burst appendix (based on US report) actually turned out to have no appendix (agenesis) , but had some fluid in the pelvis, which was sampled for culture and microscopy.
7.2.15
A total thyroidectomy with lymphadenectomy in a 35-year-old-female for FNAC diagnosed papillary carcinoma (dr Usha Chhbra, HOD anatomy’s case). Strangely, biopsy was reported as Hashimoto’s thyroiditis!. 
An adult intussusception, a TEP hernia repair converted to open repair and an anomalous Luschka’s duct identified after division
Posted on: November 20, 2014
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. 
A Spigelian hernia, a meeting with Dr Robert Rutledge and some difficult lap choles etc.
Posted on: November 9, 2014
28.9.14
Attended a CME (by IMA) at Khanna and chaired a session on ‘mini gastric bypass’ by Dr Robert Rutledge.
6.10.14
Some difficult lap choles, in one of which the Rouviere’s sulcus showed a pulsating vessel in its base.
20.10.14
A relaparotomy for a mass in the right colon which had been deemed unresectable by the residents and a proximal ileostomy had been done. At operation, the mass was indeed found to be fixed to the posterior abdominal wall, encasing the ureter which was dissected clear. However, it remained a palliative resection. The ileostomy was taken down and an EEA (Ileocolic) performed. Biopsy was adenocarcinoma. To be referred for chemotherapy.
30.10.14
Incisional hernia at the medial end of a Kocher incision for open cholecystectomy. A 55 years old lady, known to Dr Didar Singh Walia (forensic medicine). Mesh placed in a the preperitoneal space.
3.11.14
A lap chole in a young (25 years old) male, who was admitted with acute cholecystitis. The gall bladder was thick-walled and showed patched of gangrene in the fundus. Difficult dissection of the triangle of Calot.
8.11.14
A Spigelian hernia in a hefty 40 years old patient, weighing over 90 kg. Presented like appendicitis with pain in the right lower quadrant. The CT however made the diagnosis. Through a lower midline laparotomy, the congested ileal loop trapped in the hernial sac was released from the neck of the sac. The sac was excised and a prolene suture repair, reinforced with a patch of mesh between the muscles and the peritoneum, performed.
Renal cell carcinoma
Posted on: September 19, 2014
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.
Roux-en-Y duodenojejunostomy for SMA syndrome, a stricture at the lower end of ureter, a bad anal fistula, Harmonic lap choles, two wrong diagnoses, and a subtotal colectomy
Posted on: August 14, 2014
15.6.14
A wrongly diagnosed stone at lower end of ureter was found to have no stone, and actually a stricture for which the ureter was reimplanted into the bladder after excising the stricture. Dr Jagga’s case, a 7 years old male child.
8.7.14
A very bad chronic anal fistula with extensive suppuration and fibrosis all around the track, all of which had to be excised leaving a deep defect in the ischiorectal fossa, that eventually healed satisfactorily. Patient reported to be very happy! Had been suffering for long and had a couple of surgical attempts earlier.
28.7.14
2 lap choles done with Harmonic scalpel, neat and clipless division of the cystic duct performed for the thesis work of a resident.
31.7.14
A disappointing day.
A presumably easy lap chole for chronic cholecystitis turned out to have what looked like extensive intraperitoneal deposits and some ascites. Transverse colon was found to be densely adherent with the anterior abdominal wall making entry of subxiphoid port dangerous. The ascitic fluid was sampled and omentum biopsied. Cholecystectomy was deemed not possible. The biopsy report surprising came out to be tuberculosis!.
A young female (35 years old, HIV positive), had a mobile big intraperitoneal mass, reported on CT as ovarian (CA 125 also elevated). At operation the clinically mobile mass was found to be a mass in the greater omentum between the stomach and colon, but had a more extensive fixed retroperitoneal component posteriorly. Only a biopsy only was possible; and this was reported as sarcoma.
11.8.14
Subtotal colectomy and ileostomy for severe ulcerative colitis (pancolitis). Young (25 years old) patient, with fulminant ulcerative colitis, which had had remissions earlier, but now had actually become more severe, with the patient having developed abdominal pain, as well as increase in the number of bloody stools (now more than 10 per day). Referred from medical ward for surgery.
14.8.14
Roux-en-Y duodenojenunostomy for SMA syndrome. The young patient (27 years old) had undergone an appendicectomy (perhaps a wrong diagnosis) at Samana about two weeks back, but continued to have abdominal pain and vomiting. Barium study revealed a dilated duodenum up to the third part.
The angle between the aorta and SMA was 15 degrees on CT angiography.
At operation, after mobilizing the duodenum, the patient was found to have omental adhesions in the right lower abdomen ( at appendicectomy site). These were lysed. Interestingly, the upper small bowel had herniated through a hole created between the loops of proximal jejunum which were densely adherent to the posterior abdominal wall.
These adhesions were divided, and the jejunal loops released, only to find some stricturing in a loop at the site of adhesions. This upper jejunal loop was excised to remove the strictures and a Roux-en-Y DJ was made for cure of the SMA syndrome as well.
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8.5.14
An anomalous bile duct encountered at lap chole and clipped.
Incidentally, the Rouviere’s sulcus in this patient was jus a slit.
12.5.14
An old man (65 years old) reported to have a mass in the caecum (on CT scan) turned out, at operation, to have an appendix abscess with gangrene of the wall of the caecum, for which resection of the caecum and an end-to-end leocolic anastomosis had to be done.
19.5.14
A difficult lap chole in an obese 55 years old hypertensive lady (dr SK Jindal’s relative). The gallbladder was almost entirely intrahepatic, thick-walled and packed with large stones. the stones were removed first to empty the gallbladder and helping to grasp the thick walls of the gallbladder. Since the Calot’s triangle was obliterated, the gallbladder neck was ligated with vicryl, and the gallbladder removed in pieces since it would not otherwise come out through the 10 mm port. The patient remained in ICU for one day, but recovered very well.
6,7,8 june, 2014
Attended the free medical camp at Baru Sahib. Performed 12 open cholecystectomies (laparoscopic equipment not available), 2 PUH repairs, one hydrocelectomy, one cystolithotomy, and 2 inguinal hernia repairs, besides excision of a couple of lipomas.
Mesenteric fibromatosis, vesicovaginal fistula and big sebaceous cysts on the scalp
Posted on: May 1, 2014
- In: conferences | operations
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10.3.14 An incisional hernia gone wrong. A young man with incisional hernia (following laparotomy for ileal perforation) had a mesh repair of the same. However, postoperatively, the suction drain started discharging darkish brown content. At relaparotomy, a loop of small bowel had been caught in the suture meant to fix the mesh. Ileostomy was carried out along with peritoneal lavage.
20.3.14 An attempted TEP hernia repair had to be converted to open repair due to poor creation of space and poor muscle relaxation.
24.3.14 A nephrectomy (anterior approach) for renal cell cancer of the left kidney in an obese 60 years old lady, c/o Dr Walia our assistant professor.
31.3.14 A difficult lap chole in a 50 year old female admitted for acute cholecystitis 3 days back. Surgery very difficult due to thick-walled empyema. The gallbladder was removed piecemeal, after ligating its neck with vicryl.
3.4.14 An open prostatectomy after a long time in a 70 years old man, with the prostate more than 120 grams in weight.
4 and 5 April, 2014 Attended the AMASI conference in Simla.
7.4.14 An easy TEP hernia repair in a direct right inguinal hernia.
10.4.14 A lap chole for acute cholecystitis turned out to be very easy!
12.4.14 Presented a case of ‘mesenteric fibromatosis’ in the clinical meeting held in the medical education cell of the college. An 11 years old child was shifted from paediatrics ward, with a history of fever but was found to be having a big palpable mass in the right iliac fossa. A CT scan showed a 10 cm big well-defined mass in the peritoneal cavity. At operation, the mass was found to be arising from the mesentery of the distal ileum. The mass and the adherent loop of ileum were resected. Biopsy revealed an aggressive fibromatosis of the mesentery.
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.Mahajan A1, Singh M1, Varma A1, Sandhu GS1, Singh M1, Nagori R1.
18.4.14 A VVF (poor 45 years old lady) following an abdominal hysterectomy in UP, was repaired abdominally. The fistula was high in the fundus of the bladder.
1.5.14 Huge sebaceous cysts on the scalp removed painstakingly, taking more than 2 hours!.
published in:
Journal of Clinical and Diagnostic Research. 2015 Nov, Vol-9(11): PJ01-PJ02
Dr Mohinder Singh's blog 