Papers by Dr. Gunjan Desai
XXIII National Conference of Indian Association of Surgical Gastroenterology, Aug 29, 2013
Exam Preparatory Manual for Undergraduates: Surgery, 2015
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016
A 47-year-old male with history of alcohol abuse for 8 to 10 years visited the Department of Gast... more A 47-year-old male with history of alcohol abuse for 8 to 10 years visited the Department of Gastrointestinal Surgery for recurrent attacks of mild acute pancreatitis since 3 years. He also had recurrent epigastric pain, significant weight loss, early satiety and postprandial fullness. Multiple ultrasonography examinations and Computed Tomography (CT) scans of abdomen done in the past suggested chronic pancreatitis for which patient was advised pancreatic enzyme supplementation, alcohol abstinence, analgesics and dietary changes by different physicians, only to recur again. CT scan revealed bulky head and uncinate process of pancreas with a hypodense area between pancreatic head and second part of duodenum [Table/Fig-1], prominent pancreatic duct, dilated Common Bile Duct (CBD) (15mm), hugely distended gall bladder, irregular wall thickening of first and second part of duodenum with stenosis of second part of duodenum [Table/Fig-2]. Upper gastrointestinal endoscopy did not reveal significant duodenal obstruction. Duodenal biopsy showed Brunner's gland hyperplasia. Endoscopic Ultrasound (EUS) confirmed the CT findings. An Fine Needle Aspiration Cytology (FNAC) showed only inflammatory infiltrate and no malignancy. Blood level of CA19-9 was normal. Liver function tests were normal.
Annals of Tropical Medicine and Public Health, 2013
Pott's spine leading to pelvic abscess is an uncommon presentation of tuberculosis. We recent... more Pott's spine leading to pelvic abscess is an uncommon presentation of tuberculosis. We recently cared for a young male who presented with a pelvic abscess without evidence of any primary genitourinary or bowel pathology. On computed tomography (CT), patient was found to have Pott's spine as the primary pathology. The pelvic abscess was drained by high transrectal drainage and its tubercular nature was confirmed by microbiological tests. Patient was subsequently stated on antitubercular drugs. Our patient is a rare and the first reported case of a young immunocompetent male who presented with a pelvic abscess as the sole manifestation of Pott's spine without coexisting psoas involvement or any neurological deficit. To conclude, any patient presenting with pelvic abscess, Pott's spine should be considered amongst the differential diagnosis especially in endemic regions.
Asian Pacific Journal of Tropical Disease, 2014
Digestive Diseases, 2019
Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatit... more Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP) is as high as 5%. It is a commonly encountered diagnostic challenge in patients with CP on long-term follow-up. Summary: This review consolidates the existing literature on assessment of PDAC in background of CP, its evaluation through the available investigations, surgical management, and prognostication. Recent change in symptomatology of an otherwise stable CP should raise a suspicion of malignancy. Endoscopic ultrasound (EUS) is more specific and sensitive in establishing the diagnosis of PDAC compared to cross-sectional imaging (computed tomography/magnetic resonance imaging). Intraoperative assessment with careful palpation coupled with careful clinical judgment helps in differentiating between an inflammatory mass and pancreatic cancer. Confirmation can be obtained with either preoperative EUS-guided fine needle cytology/core biopsy or intraoperative core biopsy under ultr...
Turkish Journal of Surgery
Objective: This article aimed to identify patient selection criteria and approach in treating per... more Objective: This article aimed to identify patient selection criteria and approach in treating persistent external pancreatic fistulas surgically with Rouxen-Y fistulojejunostomy, and the study evaluated the outcomes of Roux-en-Y fistulojejunostomy with a review of the relevant literature. Material and Methods: A retrospective data analysis from January 2010 to May 2017 revealed 6 patients managed with Roux-en-Y fistulojejunostomy for persistent external pancreatic fistulas, and their details were entered in a proforma. Standard surgical steps were performed in all patients, and the patients were followed up postoperatively for 1 year. Data were analyzed for outcomes, and the literature was reviewed. Results: Four of 6 patients had persistent external pancreatic fistulas following pancreatic necrosectomy, 1 had surgery for pancreatic pseudocyst, and 1 after pancreaticoduodenectomy for pancreatic head mass. An average duration of conservative management was 14 weeks, and Roux-en-Y fistulojejunostomy was performed at a median distance of 6 cm from pancreas via a midline laparotomy. All patients recovered without major complications. Only 1 patient developed diabetes at a 1-year follow-up. Conclusion: Fistulojejunostomy is a safe and effective treatment for persistent pancreatic fistula having the benefit of avoiding a difficult major pancreatic resectional surgery in an already debilitated patient with frozen tissue planes, along with low postoperative morbidity and mortality. The short-and mid-term outcomes in the literature for this procedure are good, as it has also been seen in our study on diverse indications.
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2020
Background: Majority of patients with large size HCC (>10 cm) are not offered surgery as per B... more Background: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. Aim: To analyze outcomes of surgery for large HCCs. Methods: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. Results: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in fi...
Langenbeck's Archives of Surgery
The Surgery Journal
Purpose Pancreaticoduodenenctomy is a complex surgery and the sequence of steps is affected by an... more Purpose Pancreaticoduodenenctomy is a complex surgery and the sequence of steps is affected by anatomical variations involving small intestine and major vascular structures. This article depicts our approach to two such cases and highlights the importance of identifying these variations preoperatively on imaging, so as to modify the surgery plan accordingly. Cases We report following two cases of pancreatic head adenocarcinoma (1) one with incomplete intestinal rotation with a replaced right hepatic artery and (2) one with intestinal nonrotation. In both cases, the small bowel was aggregated on the right side of the abdomen, making duodenal mobilization challenging. The surgical approach was modified to prevent injury to these vessels. A superior mesenteric artery (SMA)-first approach helped in early isolation of vascular structures especially when vascular anomaly was also present. Interbowel adhesiolysis, limited kocherisation, tracing all vessels to its origin before division, pa...
bowel disease with a focus on postoperative events and their management Gunjan S Desai*; Prasad P... more bowel disease with a focus on postoperative events and their management Gunjan S Desai*; Prasad Pande; Aniruddha Phadke Department of Gastrointestinal surgery, Lilavati hospital and research centre, Maharashtra, India. *Correspondence to: Gunjan S Desai, Department of gastroenterology, Lilavati hospital and research centre, Mumbai, Maharashtra, India 400050. Email: [email protected] Chapter 4 Inflammatory Bowel Disease
Exam Preparatory Manual for Undergraduates: Surgery, 2015
HPB, 2019
Conclusion: Intraabdominal bronchogenic cysts are extremely rare entities and only a handful of c... more Conclusion: Intraabdominal bronchogenic cysts are extremely rare entities and only a handful of cases occurring within the lesser sac have been described. Further, development of malignancy in a bronchogenic cyst is exceptional and one arising in a lesser sac has so far not been reported.
BMJ Case Reports, 2019
Solitary hypervascular lesion in the distal body/tail of pancreas in a patient with non-specific ... more Solitary hypervascular lesion in the distal body/tail of pancreas in a patient with non-specific abdominal symptoms is a diagnostic challenge. Neuroendocrine neoplasm (NEN) and metastasis from renal cell carcinoma are the most common differentials and intrapancreatic accessory spleen (IPAS) is the rarest of its differential diagnosis. We present, here, a case of a 56-year-old man with a space-occupying lesion in body/tail of pancreas that was preoperatively diagnosed as a NEN based on elevated chromogranin levels and hyperenhancing lesion on contrast-enhanced CT scan. He underwent a spleen-preserving distal pancreatectomy. The final histopathology revealed an IPAS.
The Surgery Journal, 2020
A 59-year-old gentleman with a history of aortic valve replacement presented with spontaneously r... more A 59-year-old gentleman with a history of aortic valve replacement presented with spontaneously ruptured hepatocellular carcinoma in right lobe of a hepatitis C virus (HCV)-related chronic liver disease with hemoperitoneum. This acute emergency was managed by transarterial embolization. Right trisectionectomy with preservation of segment IVB after augmentation of future liver remnant by transarterial chemoembolization followed by portal vein embolization was subsequently performed. Sustained virological response to HCV was attained after surgery using sofosbuvir-based regimen. He had a delayed operative bed recurrence 1.5 years later with pulmonary metastatic disease which was managed by operative bed metastasectomy with mesh reconstruction of diaphragm and sorafenib. He is on sorafenib since past 3 years and doing well at 4.5-years follow-up since the first presentation, with significant regression of pulmonary disease and no other disease elsewhere, which highlights that where the...
The Surgery Journal, 2020
Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an omin... more Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an ominous sign with 100% mortality rates. The dictum that HPVG warrants surgical intervention is challenged in the recent literature. This is because of the identification of various causes of HVPG other than bowel gangrene. Most of these newly identified causes can be managed conservatively. However, bowel gangrene, if missed, is fatal. Hence, sound clinical judgment and accurate diagnosis based on specific clinical parameters and imaging findings are important. We present a case of a young male with tumor lysis syndrome and neutropenic sepsis. He underwent treatment for a relapse of T-cell acute lymphocytic leukemia and presented with abdominal pain and distension. Computed tomography (CT) scan showed HPVG, and the differential diagnosis was neutropenic colitis or pseudomembranous colitis, with steroid use as the probable cause. The patient was managed conservatively. The case emphasizes tha...
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Papers by Dr. Gunjan Desai