DOCTOR'S GALLERY

Stories

This man from Sunderban, West Bengal came to us with severe abdominal distension and was not being able to pass feces or flatus for last 10days. He was initially treated for 6-7 days at local nursing home, then came to Kolkata to seek treatment. Here again got delayed for 2 days. We identified the case being of Intestinal Obstruction as soon as we first found him. The patient was in a completely debilitated and drowsy state, BP was not recordable, high pulse rate, minimal urine output, severe respiratory distress, fever and infection parameters were skyrocketing. The patient was admitted in the ICU and patient relatives were informed regarding the grave prognosis at this state. After initial stabilisation and recovery from Septic Shock and Acute Kidney Injury, we planned for further investigation. The CT Scan revealed a part of small intestine aperistaltic and folded along the mysentery axis, the distal part collapse and proximal part distended, considering that particular segment. An Emergency Exploratory Laparotomy was planned on the very next morning. We found approx 40cm of ileum (distal end was just 15cm from IC junction) was gangrenous, completely blackened and irreversibly damaged. The reason was blockage of blood flow into that segment following internal herniation along that mesenteric axis. The gangrenous part of the bowel was removed and considering the fact that patient was hemodynamically unstable as well as nutritionally depleted, we planned on exteriorising the cut ends of small intestine outside the abdomen in the form of Double Barrel Ileostomy. In this stoma, the fecal material is going to come out and get collected in a bag, rather than coming out of the natural orifice, anus. The operation was completed in a span of 2hrs and the patient was extubated without any adverse event. The post operative recovery was rather remarkably fast and on day 4 after operation, he had started taking liquid diet orally. Now the patient is ready to be discharged by day 8.

#drdiptangshudas KPC Medical College & Hospital, The KPC Group

SIMPLE BUT INCREDIBLE
A straight forward operation - Exploratory Laparotomy followed by resection of gangrenous segment of distal ileum and then double barrel ileostomy !!! NOTHING FANCY... The only thing was the place and the surgeons. A relatively new pvt medical college with only the second batch of post graduates; This was the first instance in the history of this college where such a major case was done by PGTs only. Being the concerned Consultant, stood while our 1st yr PGT took the picture. Most of the medical professionals might be thinking, there is nothing new in this, innumerable such operations are done everyday. But, it's incredible to me, because it felt great to be shaping the future.

#drdiptangshudas KPC Medical College & Hospital, The KPC Group