Rare Cases

Robot-assisted Bladder Diverticulectomy: An interesting case scenario

A male patient with severe diculty in passing urine came to Max Super Speciality Hospital, Patparganj. On ultrasound examination, it was found that his prostate was more than 200 cc which is ten times than normal prostate size. Both hips were fixed due to ankylosis of the hip joints. His serum PSA was normal, so there was no suspicion of prostate cancer. The usual surgery doctors opt for prostate is TURP/HOLEP, in which hip joints are flexed to put the patient in a lithotomy position. This was impossible in this case due to ankylosis of the hip joints. The only option was an open surgery (simple prostatectomy or Freyer’s procedure).

Treated by - Dr. Pawan Kesarwani, Dr. Shailesh Chandra Sahay

Endobronchial Balloon Tamponade using a Fogarty catheter

Haemoptysis is a medical emergency and needs urgent intervention. If not managed, the outcome can be catastrophic. Even if the patient stabilises post-bleed, the clots need to be evacuated to prevent secondary collapse or infection in the lung and also to decrease the oxygen requirement of the patient. Massive haemoptysis may even require emergency thoracotomy or BAE, which cannot be oered to a critical patient.

Treated by - Dr. Vaibhav Chachra

A case of STEMI with post-MI Angina: Role of intravascular imaging

A 50-year-old normotensive, euglycemic, smoker man with a history of a recent inferior wall MI, post-PTCA to LCX, came to Max Super Speciality Hospital, Dehradun, with complaints of chest pain on minimal exertion for a few days. His vitals were normal, and ECG showed q and T wave inversion in leads II, III, and AVF. 2D Echo showed LVEF 50% with RWMA in the inferior territory. Diagnostic angiogram revealed OM- 80% stenosis, LAD 50% stenosis.

Treated by - Dr. Preeti Sharma

A rare case of non-resolving Pneumonia in the ICU

A 43-year-old woman was admitted to ICU for left upper lobe pneumonia with hypoxemic respiratory failure. CT thorax revealed consolidation with ground opacities in the left upper lobe and lingular segment. A bronchoscopy was done, and cultures were sterile. However, despite many courses of empiric wide-spectrum antibiotic treatment taken before admission, respiratory failure and radiological opacities persisted.

Endovascular Coiling and Multidisciplinary Care achieved an Excellent Outcome

An eighty-year-old lady came to the emergency of Max Super Speciality Hospital, Saket, in an unconscious state. On evaluation, she was found to have a high-grade subarachnoid haemorrhage due to a ruptured basilar artery aneurysm. Her family was updated about the same. They were extensively counselled and made clear that survival in such cases at her age is only about 20-30%, despite the best treatment.

Treated by - Dr. Himanshu Agarwal, Dr. Prakash Singh

case of large bilateral tubo-ovarian masses with pelvic adhesions & severe sepsis managed

A complex and high-risk case of large bilateral tubo-ovarian masses with extensive pelvic adhesions and severe sepsis managed successfully.

Treated by - Dr. Anuradha Kapur

India's first robotic surgery performed for treating sweaty palms

In a first-of-its-kind procedure, doctors at Max Super Speciality Hospital, Saket, performed robotic surgery to permanently eliminate the issue of excessive sweating in a 24-year-old woman. This is the first time high-precision robotic surgery has been performed in India to treat the issue of excessive sweating.

Treated by - Dr. Shaiwal Khandelwal

Life-saving emergency Laparoscopic surgery for Perforation Peritonitis with Septicaemia

A 46-year-old male diabetic, hypertensive, hypothyroid patient, came to the emergency with severe pain in the right lower abdomen for 2 days. On examination, he had hypotension and tachycardia. On abdominal examination, distension and guarding rigidity were observed. The doctors had a suspicion of perforation peritonitis. The patient was immediately shifted for CT abdomen, which showed thickened and retrocecal appendix, with hyperdense intraluminal foci suggestive of appendicoliths, and there was marked adjacent fat stranding and thickening of peritoneal reflections

Treated by - Dr. Ashish Vashistha

Internal Carotid Artery Aneurysm Treated by Endovascular Flow Diverter

A 67-year-old lady had complaints of progressive visual deterioration. On evaluation, she was found to have a giant left supraclinoid internal carotid artery (ICA) aneurysm with a left middle cerebral artery (MCA) bifurcation bleb. Surgical clipping was tried for the aneurysm before at another hospital but was abandoned. She was referred to Max Super Speciality Hospital, Saket, for further management. She underwent Flow Diverter Placement with some coils in the aneurysm.

Treated by - Dr. Himanshu Agarwal, Dr. Arun Saroha

Robotic Abdominal Wall Reconstruction for complex Abdominal Hernia: Modern Hernia surgery

A middle-aged woman came to Max Super Speciality Hospital, Mohali, with abdominal wall swelling for the past 8 years, associated with increasing pain for last 3 months. She had undergone explorative laparotomy for intestinal perforation, followed by wound dehiscence 12 years back. On clinical examination, she was found to have multiple swiss cheese pattern defects in the midline from epigastrium to supra-pubic region, with bowel loop as contents in multiple hernia defects. She was optimised medically and investigated with Contrast-Enhanced Computed Tomography (CECT) Abdomen, to assess abdominal musculature and hernia anatomy in detail.

Treated by - Dr. Anupam Goel

Successful Multivisceral Resection for advanced Colonic Cancer in a neglected Cachectic patient

A 60-year-old patient was diagnosed with hepatic flexure colonic adenocarcinoma with duodenal (1 st & 2 nd part) infiltration in December 2021. Initially, he received neoadjuvant chemotherapy, to which he responded partially. He then defaulted from treatment. Over time, his condition worsened with recurrent vomiting, poor oral intake and significant weight loss.

Treated by - Dr. Vivek Mangla

Stroke can strike at any age: early treatment can save life

A 32-year-old female came to the emergency with sudden onset right haemiparesis with global aphasia of 45 minutes. After initial triaging in emergency, a stroke code was alerted.

Treated by - Dr. Vivek Kumar