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| GROSSLY DILATED STOMACH UP TO PELVIS DUE TO GASTRIC OUTLET OBSTRUCTION,AND OLD G.J STOMY STENOSIS |
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| old g.j. site near prepyloric area from which the stenosed loop of jajunum was seperated. |
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| Billroth 2-gastrectomy closed partialy to allow revision g.j. by roux- en- y- loop |
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| stomach specimen |
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| all anastomosis completed. |
a 35 yr old male presented with severe abdominal pain presented in emergency.he had h/o some abdominal surgery 15 years back,no papers available. o.g.d. scopy revealed complete pyloric stenosis with severe gastric dilatation .no g.j stomy was appreciable.on ct scan , stomach showed severe gastric dilatation and block. on exploration , old stenosed gj stomy was found in prepyloric region with ? mass, loop separated an on table frozen section done which was negative for malignancy.so revision billroth2 gastrectomy with roux-en-y g.j.stomy was done. uneventfully post op,on 7 the day pt was discharged home absolutely fine , taking orallyfood .done by ME,DR DHAVAL PATEL, DR VYAS, DR RANPARIA,emergency frozen section done by DR PRANAV DESAI.
Why bilroth II he is just 35..scopy did not showed tumor..and patient was alive for 15 yrs after GJ
ReplyDeleteWhy not RY GJ
as we had talked personally,keyur it was a mass at prepyloric region,totally blocked lumen at antrum, old gj was done at that area,if we leave that area on table there were doubts in the mind of the whole ot team,although the the frozen section showed benign condition, the pathologist himself told on phone that in certain highly anaplastic tumors, if the biopsy is from necrotic debries(the sample what we had sent for frozen) it can show nonmalignant features in frozen,but actual specimen can show malignancy.that was the reason for resection of the mass with billroth 2 roux en y.
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