31 Yr male patient presented with.C/o- Left hypochondric region discomfort and intermittent pain 1 yr,Generalised weakness, H/o manena (intermittent) since 3 yrs
Blood Investigations:
Hb- 5.2 WBC – 2740 PLT- 82000
Bili T/D- 0.8/0.5, SGPT- 16.7, SGOT- 18.6, ALP-36.9, Sr albumin- 3.85
HBA1C- 6.6, Coombs (D)(I): Neg.
Liver Biopsy: portal fibrosis with steatosis
UGI endoscopy: – Gr-III esophageal varices, Mild PHG, EVL done 3 times
USG (Abd): – liver shows coarse echotexture, small in size, no IHBRD, Gross splenomegaly (21cm) , mild ascites, GB partially distended with minimal sludge, CBD normal in size.
USG Liver elastography: – Avg liver stiffness is 10.1 Kpa (mild fibrosis).
Spleno-portal Doppler study: – Patent splenic vain (1cm), left renal vain patent (1cm), multiple dilated collaterals present at splenic hilum, gastrosplenic levels
CECT Abdomen: – liver small in size, splenomegaly, dilated splenic vain, portal vain patent and dilated, Gb and CBD normal, no ascites, pancreas normal.
Diagnosis: – NCPF, Gross splenomegaly, Pancytopenia, Gr III esophageal varices, EVL (3 times), Multiple blood transfusion, Type 2 diebetes.
Plan: Vaccination done (pneumococcal, meningococcal, H influenza)
Indication for surgery: – Symptomatic hypersplenism, Transfusion dependent, Recurrent EVL, Remote area.
Surgical Procedure: – Open splenectomy f/b Proximal splenorenal Shunt (PSRS) (Size- 10mm)
Post Op Period: – Oral diet started on POD 1,ADK drain removed on Pod 5Pt discharged on POD 6, uneventful.
Follow up period:- Sutures removed on POD 15, No collection, USG doppler study shows patent PSRS shunt.
Procedure done by–
- Dr Harshal S. Bhoi. (MCh. Surgical Gastro)
- Dr Dinesh (Anesthesia)
- Dr Tejas Kulkarni (Anesthesia)
Place of Surgery: – Antrang Hospital Kolhapur.
Medical Gastroenterologist: –
- Dr. Vivekanand Kulkarni (Senior Gastro)
- Dr Aditya Kulkarni (DM Gastro)
