sigmoid volvulus

 About  38yr old female had  gross fecal impection  due to huge feacolith of a cricket ball size  at rectosigmoid region.she had acute obstruction  with sigmoid volvulus. feacolith was dismpected ,menual per rectal removal  was done,considering young age and negative history of chronic constipation, simple plication of sigmoid colon was done( as per literature colon resection is recommanded). patient was fine and post op uneventful, had followup of about 1 year with satisfactory result. in 2  similar cases we had put the sigmoid colon in the subcutaneous space also by  inguinal incision, all the pt who were co-morbid and high risk for resection,they have also behaved well but constipation is always an issue in patients without resection.few cases were done with resection and results were better(unfortunately no pictures available).  two patient had leak from resection site, and converted in to colostomy.nowadays due to good bulk forming agents ,incidence of sigmoid volvulus are decreasing.(this post is not in favour of plication against resection)

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

Add caption

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)