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 General Surgery

Dr. Kamath Unit

Name: Allasab                                                                      

Age :70yr/MALE

Occupation : Agriculture

Pain abdomen on and off 4 months

Increased since 4 days

Colicky,3-4 hrs after  food intake,with bloated sensation

Fever : 4 days

O/E :

Moderately built poorly nourished

Pallor +,

Pulse: 110, low volume

Saturation: 82%

BP: 90/ 06

CVS : S1 S2 +

R S: b/l air entry +

P/A:

Inspection: distended

Umbilicus central

Movements with respiration restricted

Palpation:  Gaurding  +

Rigidity +

Percussion: liver dullness obliterated

Free fluid +

Auscultation BS absent

PR empty

CBC:

  Hb: 8g

 TC

 DC

  ESR

 Creat: 4mg

 Urea: 120mg

 X ray erect abdomen:

 

 

Treatment:  resuscitation started immediately

2 pint NS

2 pint RL

Oxygen inhalation

Catheter

Ryles tube aspiration

i.v. antibiotics

Blood arranged

Shifted to OT after stabilaisation(8 hrs)

INTRA OP: 2  lts. of  feculent fluid aspirated from peritoneal cavity

Jejunal diverticulum of size 3*4cm seen at about 2 feet from DJ junction, gangrenous, perforated,

um of size 3*4cm seen at about 2 feet from DJ junction, gangrenous, perforated,

 

 

 

Another Diverticula 3*4 cm 2 feet distal to first one 

 

Segmental resection of perforated jejunum with end to end jejuno jejunal anstamosis done 

 

Abdomen closed with drain in situ

 

Patient shifted to ICU

 

On ventilator

 

Extubated on day 2

 

HPR awaited

Neuro Surgery Dept

SKIN Dept KIMS Hubli

Dept Of Ortho

1. AVN of bilateral hip in 36 year old male patient treated conservatively: A CASE REPORT

By : DR PRASHANTH KUMDR Dr. SURESH KORLAHALLI

                                                     DR SURYAKANTH K

A 36 year old patient with bilateral hip pain and limp of nine months gradually progressed to  rest pain with inability to squat and low back ache. Then he was referred to an orthopaedician who suggested THR of left hip and core decompression of right hip. Then he moved to KIMS for treatment because of non affordability.

 Radiograph revealed left hip anterolateral segmental collapse with subchondral  sclerosis with involvement of 50% of head. Right hip had metaphyseal lucency with sclerosis. This reports lead to the diagnosis of bilateral AVN left > right. Patient was also diagnosed with early spondylosis. Blood investigations revealed borderline anemia and hypertriglyceridemia.

Patient was managed conservatively with

  • Traction with 3 kg weight for bilateral lower limbs
  • Physiotherapy: Muscles around hip stretching exercises, strengthening exercises, passive and active movements with resistance exercises, quadriceps and hamstring exercises, along with upper limb exercises.
  • Zolendronic acid 5mg i.v. infusion during hospitalization.
  • Calcium, iron, vitamin D3, methylcobalmin supplementation.
  • Patient was discharged after 3 weeks advising to have balanced diet, to continue same exercises at home and to attend his routine work.

Results: Clinically patient had both hip full range of movements within 2 months, limping stopped in 2 weeks. The triglycerides level without Clofibrates touched base line, anaemia improved, back pain was relieved.

Monthly x ray both hips and pelvis and both hips lateral view were taken which revealed reduction in lucency and sclerosis of both femoral head with rebuilding of trabecular pattern with improvement in osteoporosis and disappearance of acetabular osteophyte. Rebuilding of vertical trabaculae seen. Sphericity was maintained. MRI on 14th month showed revascularization of trabaculae with maintenance of articular cartilage without hyper intensity in T2 images.

 

This case report has been published at various state level conferences and had been awarded.

2.

TUMOR CALCINOSIS: A CASE REPORT

Presented by :       Dr S F Kammar

                           Dr Prashanth Kumar

                           Dr Gururaj Murgod

A 15 year old male patient presented with the chief complaints of right elbow swelling with discharging sinus since 5 years . Left elbow swelling and ulcer over left gluteal region since 3 years . He under went surgery twice 3 and 4 years back in Belgaum but no relief of symptoms. Later patient presented to KIMS ortho department for the same. On further blood and radiological investigations patient was diagnosed as tumour calcinosis, a rare condition. Complete excision of the periarticular tissue around elbow and gluteal region. Aggressive physiotherapy was instituted.

At 4 months of follow up the symptoms were relieved, and the range of movements improved and he could do all his routine activities.

 3. 

PROXIMAL RADIUS RECONSTUCTION BY METATARSAL OSTEOCHONDRAL GRAFT-A RARE SURGERY DONE

 

TEAM

 

DR S F KAMMAR-UNIT CHIEF (ORTHO C UNIT)

 

DR PRASHANTH KUMAR (SENIOR RESIDENT)

 

DR GURURAJ MURGOD(ASST PROFFESOR)

 

A patient named pavan hadimani,15 yrs old came to KIMS hubli,admitted in ORTHO C Unit with pain and swelling of right elbow since 8 months.On further clinic-radiological evaluation and biopsy was found to be ANEURSYMAL BONE CYST and curettage and bone grafting was done.6 months later patient came back with same complaints.On further evaluation with x ray and MRI it was confirmed as recurrence of above condition. Surgery was done where we excised the tumour and was reconstruction of excised radial head was done using  3 rd metatarsal base as a radial head,augmented with fibular graft  and fixed with plate and screws.

 

 

At 6 months of follow up patient has achieved good range of painless movements at the elbow, able to do all his routine and academic activities.

 

This paper has been presented at state level conference and has received accolades from the orthopaedic fraternity.