very huge pleomorphic adenoma of minor salivery glands of neck

before surgery

mass already extended out of its capsule

mass  kept near 8 inch artery forceps

after  surgery, no facial palsy or  other neurovascular deficit.

left congenital eventration of diaphragm-simple plication

left congenital eventration of diaphragm, whi included part of stomach small bowel and part of colon, reduced and diaphragm plicated with vicryl no -1. considering peadiatric age of that pateint.

mesenteric tear in a child due to run-over crush injury.

alleged  history of run over injury by tractor in a 8 year old child, laparotomy showed long complete mesenteric tear with devasculerization of long ileal loop, compelled us to resec long segment of ileum and part of jajunum.jajuno-ileal anastomosis done .pt discharged on 7 the post op day uneventfully.

esophageal atresia and tracheoesophageal fistula in new born

very huge phylloid tumor rt breast surgery

a 65 yr old ladyhad gian breast mass for about 10 years.simple mastectomy was done, biopsy suggestive of  giant phylloid tumor. 

delayed intraperitoneal rupture of liver heamatoma(posttraumatic)

liver fossa poacked to controll torrential uncontrolled heamorrhage

packs were removed and count confirmed

late pre op ct scan abdoman showing large heamoperitonium rt lower abdoman

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early pre op ct scan showing intraparenchymal heamatoma without heamoperitoneum.

 A 68 yr old male had h/o road traffic accident 6 days back ,usg s/o intraparenchymal liver heamatoma, no free fluid, ct scan confirmed the diagnosis.pt refused to get admitted as he was vitally stable,on 8th post trauma day he got sudden breathlessness,got admitted under a cardiologist( past h/o balloon angioplasty)vitally stable( stopped antiplatelets after the day of trauma), repeat usg showed same previous findings, pt kept in icu for one day and then in ward for one day before discharging him, treated conservatively, but suddenly on the day of discharge ,he had breathlessness, perspiration, hypo tension and abdominal distension.repeat ct-scan suggested gross heamoperitoneum. pt was taken for laparotomy, with  radial pulse not palpable and bp not record-able condition,on exploration about 3 lit of fresh heamoperitoneum drained with active bleeding from seg-4 and seg 6-.pringle menuver failed to control active heamorrhage, surgicel and fibriller also failed ,packing with mop done which arrested h'hage, but after removal of packing for 8 to 10 min  again severe haemorrhage continued,despite of all alll attempts due to grave condition of the pt, I  decided to pack the liver fossa wid 1 roller pack and six mops,soaked wid hemlock and hydrogenperoxide,.blood and blood products were given (about 20 units total).pt improved  drametically was on ventilator,after 48 hours packs were removed,and counted.heamostasis achieved with gelfoam , fibrillar and surgicel.pt imroved in 2 day but then got acute lung failure (ARDS) and modf status. pt was kept again on ventilator for another 12 days and gradually improved. all culture (8 in number) were sent , few were positive for acenatobacter and enterococcus,antibiotics given accordingly pt was discharged on 20th post op day,

4 days back he completed 2 months after discharge ,happy to save someone"s life in such a hostile condition.( this is the shortest discription of this case possible)

Post traumatic jejunocolic internal fistula

jejunum strongly adharant to sigmoid colon due to internal fistulization

internal fistula

fistula separated

colonic opening confirmed by feeding tube entering to the colonic lumen after the separation of jejunum

colonoscopy confirmed enterocolic fistula pre op

ct scan confirmation of oral contrast entering from jejunum to sigmoid colon

 a case of 45 yr old male having h/o blunt trauma 6 wks back,pt was diagnosed small bowel perforation with peritonitis after 7-8 days of trauma. he was operated in periphery by a  senior surgeon who  did laparotomy in  7-8 days old bad peritonitis. according to his view, pt was having about 1.5 liter of pus with bilious and fecal peritonitis,he gave lavage and did a proximal ileostomy from a site upto which he was able to trace normal bowel. pt went into septic shock and shifted to surat  was on ventilator for 5 days, recovered. pt was planned for ileostomy closure after about 5 weeks of first surgery. pre op evaluation suggested jejuno-colic internal fistulization confirmed on ct scan and colonoscopy. exploratory laparotomy was done, jejunocolic fistula was noted, seperated dirty granulation removed. colonic opening confirmed with feeding tube ,closed in two layers with silk 2.0.jejunal loop separated from colon was excised resection anasotmosis done, ileostomy was closed , which was distal to the  jajunal resection-anastomosis site. mass closure of abdomen done.post op, pt  recovery was uneventful. discharged on 7 the post op day, now after  1 month pt is absolutely fine. still we all are trying to find the actual cause for internal fistulization,biopsy has not shown any signs of chrohn's  disease, no diverticulitis disease of colon.at present probably primary traumatic jejunocolic fistula is the diagnosis.please comment.... case done by me, dr dhaval patel  and anesthetist team of baps hospital.