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AN EXTREMELY RARE SURGICAL EMERGENCY BECOMES PART OF THE PANDEMIC

A 75 year old obese hypertensive lady had been presented in the Emergency department of Ruby General Hospital at midnight after being referred by a couple of hospitals of the city, with complaints of severe pain, breathing distress and eviscerated bowel (bowel came out of the body through a perforation on the skin covering of Hernia sac) from a long standing ventral hernia. It is an extremely rare surgical emergency. She had been admitted under the expert care of Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon), who had rushed to the Emergency so late in the night, that also, at a time when all are refraining from staying outdoors. After initial measures, he put the bowel inside the hernia sac under local anaesthesia and closed the hole of the skin. After further evaluation, the lady had been shifted to the ICU and necessary investigations were carried out. Unfortunately, she tested positive for COVID 19 and was kept in isolation ward under close observation and the condition of the huge hernia had been checked daily as there was a chance of getting it strangulated or obstructed. The family members were very anxious as they were losing all hope for their dear one. On the fifth day of admission, she tested negative for COVID 19 and the consultant decided to operate on her with all precautionary measures. It was a real challenge to manage such a big hernia both from surgical and anaesthetic point of view as these patients can have abdominal compartment syndrome (ACS results from the progression of steady-state pressure within the abdominal cavity to a repeated pathological elevation of pressure above with associated organ dysfunction) in the postoperative period and lead to cardio-respiratory failure followed by death of the patient. The lady had been posted for surgery which took almost three hours and abdominal wall reconstruction along with mesh repair had been done under general anaesthesia. The post operative period was uneventful and she is back on her feet to walk back home to her family whom she thought she would never be able to meet again. The lady had also been seen by Dr. Arindam Roychoudhury (Consultant Medicine), Dr. Dibyadip Mukhopadhyay (Consultant & In – Charge Critical Care & Pain Management), and Dr. Dwaipayan Jha (Consultant Anaesthetist).

 

At this age she has beaten both Corona and a complex ventral hernia. She has also said, “I am extremely happy with Dr. Sumanta Dey and the nurses at Ruby, they gave me a second life. I will suggest everyone …. not to neglect their other medical issues by being afraid of Covid 19” Her family members had been in home quarantine during the treatment period and they were extremely happy to take her home.

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