Publications by authors named "Dhananjay Saxena"

4 Publications

  • Page 1 of 1

Our experience with surgery in situs inversus: Open peptic perforation repair and laparoscopic cholecystectomy in 1 patient and 3 patients respectively.

Int J Surg Case Rep 2016 19;29:34-38. Epub 2016 Oct 19.

Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India. Electronic address:

Introduction: Situs inversus is a rare autosomal recessive condition associated with complete transposition of abdominal+/- thoracic organs. Surgical diagnosis and surgical procedures in patients with situs inversus is tricky because of the mirror image anatomy of intra-abdominal organs.

Materials And Methods: A retrospective analysis of 2152 and 1497 patients who underwent laparoscopic cholecystectomy and open peptic perforation repair respectively from June 2014-June 2016 was done. 1 patient and 3 patients with situs inversus underwent open peptic perforation repair and laparoscopic cholecystectomy respectively. A 10mm left para-median port 5cm caudally from xiphoid was used for grasping the infundibulum. Two 5mm ports placed 10cm caudally from costal margin in the mid-clavicular and anterior axillary line were used for dissecting and retracting fundus respectively. A 10mm supra-umbilical camera port was used.

Results: A 40year male with situs inversus totalis underwent open peptic perforation repair. Laparoscopic cholecystectomy was done in 3 female patients with situs inversus aged 33-46year (mean 41year). Mean operative time for laparoscopic cholecystectomy was 59min (39-93). There were no intraoperative or post-operative complications. Histopathology revealed chronic inflammation in peptic perforation and cholecystitis.

Conclusion: Perforation peritonitis in situs inversus can cause diagnostic confusion with free gas under the left hemi diaphragm. Laparoscopic cholecystectomy in situs inversus is ergonomically inconvenient and technically difficult for right handed surgeons. We describe an ergonomically convenient port placement for right handed surgeons in situs inversus.
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http://dx.doi.org/10.1016/j.ijscr.2016.10.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094291PMC
October 2016

Management of presacral tumors: Our experience with posterior approach.

Int J Surg Case Rep 2015 12;12:37-40. Epub 2015 May 12.

Department of General Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan 302004, India. Electronic address:

Introduction: Presacral tumors are a rare variety of space occupying lesions arising in the presacral space. Most of the tumors are congenital in origin. Due to obscure anatomic location, difficult surgical approach and etiological heterogeneity, tumors arising here pose a diagnostic and therapeutic challenge. We report our experience of 10 cases of presacral tumors with posterior approach being used in 6.

Materials And Methods: A retrospective analysis was conducted on 10 cases of presacral tumors managed at our hospital during a period of 14 months (May 2013-July 2014). 9 cases were operated while one had advanced disease and was referred for palliative care. Complete en bloc excision of the mass was possible in 8 cases. Finally, presenting complaints, clinical diagnosis, surgical procedure and histopahological findings of the cases were studied.

Results: All of our patients were females in the age group of 18-50 (mean 28.4) years. The pathological findings included schwannoma, leiomyosarcoma, hemangiopericytoma, neurofibroma, paraganglioma and rest were developmental cysts. 6 cases were managed using the posterior approach and rest by anterior approach. There was no major complication or mortality in the follow up.

Conclusion: Complete surgical excision remains the mainstay of therapy. Surgical approach depends upon the location, size, local invasion and surgical expertise of the surgeon. Benign tumors have a good prognosis while the prognosis in malignant tumors remains guarded due to difficulty in obtaining safe resection margins. Posterior approach is an attractive option for low lying, benign tumors that is more direct, with better exposure and quicker recovery.
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http://dx.doi.org/10.1016/j.ijscr.2015.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486097PMC
June 2015

Malroatation of gut with superior mesenteric artery syndrome and multiple jejunal diverticula presenting as acute intestinal obstruction in 6th decade: A rare case report.

Int J Surg Case Rep 2015 24;6C:1-4. Epub 2014 Nov 24.

Department of General Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan 302004, India. Electronic address:

Introduction: Intestinal malrotation is a disease of neonates and young children presenting as acute intestinal obstruction. Presentation of malrotation in elderly patients with intestinal obstruction is quite rare with only a few cases reported in literature. We report a case of intestinal malrotation presenting as acute obstruction in sixth decade.

Presentation Of Case: A 55 years old male presented to the emergency with features of acute intestinal obstruction. Imaging studies revealed intestinal malrotation. Exploratory laparotomy revealed malrotation with compression of 3rd part of duodenum and terminal ileum by superior mesenteric artery with multiple jejunal diverticula. Bypass procedures (duodenojejunostomy and ileo-colic anastomosis) with appendicectomy were done.

Discussion: Malrotation of gut is an anomaly usually presenting in neonatal period with complications such as midgut volvulus. Presentation in adult age is rare with most cases being asymptomatic. Ladd's procedure is the operation of choice with division of the Ladd's bands and appendicectomy being performed.

Conclusion: Surgeons should keep a flexible approach in management of malrotation of gut presenting in late stages of life as more and more clinical variants to the presentations described in literature are being encountered.
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http://dx.doi.org/10.1016/j.ijscr.2014.11.063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334492PMC
January 2015

Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses.

Int J Surg Case Rep 2014 23;5(10):717-9. Epub 2014 Aug 23.

Department of General Surgery, S.M.S. Medical College, JLN Marg, Jaipur 302004, Rajasthan, India. Electronic address:

Introduction: Ileal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch.

Presentation Of Case: A 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done.

Discussion: The IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients.

Conclusion: The diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA.
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http://dx.doi.org/10.1016/j.ijscr.2014.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189055PMC
October 2014
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