| Discussion in 'All Categories' started by Hussain - Apr 20th, 2017 8:41 pm. | |
Hussain
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I seek referral with you for the surgical treatment of my cousin. He is 62 years old. Since more than 20 years he has been suffering from recurrent heart burn. Through the nineties he was seen repeatedly by a Harley Street Gastroenterologist in London with repeated endoscopy and diagnosis of distal esophageal stricture, reflux and distal esophagitis with associated gastritis. Balloon dilatation was not performed. over the years he has had progressive worsening of his symptoms. During the last few years he has developed dysphagia. At this point in time he can swallow only specific soft foods after extensive chewing and with frequent gulps of water. Two years ago an endoscopy was attempted by an experienced Gastroenterologist in Mumbai without success. At that time a barium meal examination showed a large hiatus hernia. Without recourse to a flouroscopic unit i performed a limited study by giving him Barium to drink and obtaining plain films of the lower chest and abdomen. These views demonstrated a para-esophageal hernia, intrathoracic stomach, organo axial torsion around the long axis and an apple core lesion in the gastric antrum, highly suggestive for adenocarcinoma. On CT of the abdomen this appears to be early lesion with no infiltration into the adjacent fat or obvious subcarinal, paraesophageal or upper abdominal lymphadenopathy. We are making this written consultation to see if his condition is amenable to laparsocopic surgery and whether you will be able to accept him as a paying patient.In a separate email I have forwarded to you pertinent CT and Barium images. I am attaching his CT report herewith. |
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re: Large Hiatus Hernia
by Dr J S Chowhan -
Jun 6th, 2017
8:38 pm
#1
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Dr J S Chowhan
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Dear Dr Hussain in this case few more investigation is required and after that laparoscopic surgery can be planned. The diagnostic laparoscopy for staging of gastric cancer ensures the avoidance of unnecessary laparotomy in one-third of the cases. The laparoscopic surgery in gastric cancer is applied with increasing frequency nowadays. The laparoscopic resection of gastric cancer is based on the advantages of laparoscopic surgery for gastrointestinal cancer, which generally include milder postoperative course, better respiratory function and increased immune response. In this context you can refer the patient to us and after further examination we can decide course of action. With regard Dr J S Chowhan |
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