drjact Jun 15, 2012
Surgery Specialty: Colon and rectal surgery
Dr John Thanakumar/n82 yr old male presented 2 years ago with carcinoma stomach- he had undergone 30 years a gastrojejunostomy for peptic ulceration. He underwent subtotal gastrectomy with D2 lymphadenectomy for...
Dr John Thanakumar/n82 yr old male presented 2 years ago with carcinoma stomach- he had undergone 30 years a gastrojejunostomy for peptic ulceration. He underwent subtotal gastrectomy with D2 lymphadenectomy for carcinoma./nNow after 2 years he presented with clinical evidence of large gut obstruction; CT confirmed splenic flexure obstruction. Radiologically there was no obvious tumor.Endoscopy showed no tumor nor did colonoscopy , but confirmed splenic narrowing./nFailure of drip and nasogastric suction with progression of obstruction necessitated surgery. He had evidence of suggestion of mass formation in splenic flexure area to the retroperiotoneum. Frozen section did not reveal any tumor. It was not possible to dissect this mass away in the presence of obstruction./nA transverse colostomy was done and a peroperative colonoscopy via the colostomy showed the narrowing from which frozen sections were sent and these too were negative./nThe laparotomy was done via the left transverse incision and patient recovered from obstruction with the colostomy palliatively.
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