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.

situs inversus totalis -laparoscopic appendicectomy

adhesiolysis for adharant small intestine in pelvis with recurrent obstr...

ruptured ectopic pregnancy with massive bleeding in abdoman.wmv

laproscopic cholecystectomy with simple bipolar maryland forcep.wmv

re-do- roux-en-y billroth 2 gastrojajunostomy for benigh gastric outletobstruction in old G-J STOMY

GROSSLY DILATED STOMACH UP TO PELVIS DUE TO GASTRIC OUTLET OBSTRUCTION,AND OLD G.J STOMY STENOSIS

old g.j. site near prepyloric area from which the stenosed loop of jajunum was seperated.

Billroth 2-gastrectomy closed partialy to allow revision g.j. by roux- en- y- loop

stomach specimen

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.

huge left lobe liver cyst-laparoscopic fenestration and omentopexy

left lobe nonprasitic hepatic cyst

about 2.5 to 3 liters of amber clour fluid aspirated.

hepatic cyst wall falgurated with bowa vessel sealer

fenestration completed, wall sent for biopsy,lavage given

omentopexy done

a 55 yr male having c/o lump in abdomen with heaviness in abdoman since 6 months,unable to take food, persistent vomiting.the huge intraabdominal mass covering all quadrants of abdomen turned to be diagnosed as huge left lobe nonparacytic hepatic cyst on sonography and CT SCAN. no other cyst in pancreas or kidney.his LFT and other blood reports were normal, with low hb. hydatid antigen test was not done.alfa fetoprotein was boarderline raised,laparoscopic aspiration was done, about 2.5 litre of amber colour fluid drained which was not bile-stained. pus-flakes we removed, liver cyst wall was falgurated with BOWA VESSEL SEALER DEVICE( recommended because there are chances of bile leak from the cyst wall).thorough wash was given , omentopexy done , 32 no. abdo drain kept in cavity .done with four port technique. biposy confirmed the diagnosis of benign hepatic cyst. done by ME, dr bhavin bhuva, dr chetan morawala at naveli hospital. post-op phase was uneventful, pt was discharged on 4rth postopday .now after about 10 months ,pt is fine and without recurrence.