SurgeXperiences 1.03

Welcome to the third edition of SurgeXperiences, the first carnival of surgery. I’m honored to bring you this surgical carnival.

This will be a practical and concise edition. The objective of blogs (in my point of view) is to answer questions as quickly as possible, so lets start with the HOW-TOs. Enjoy.

Thank you for your time and participation. Make sure you read the next edition of SurgExperiences, created by Jeff Leow

Next week’s SurgeXperiences

I am pleased to announce that the new edition of SurgeXperiences is going to be hosted here at Unbounded Medicine next week. I’ll be accepting ALL your submissions.

Please feel free to post about anything related to surgery, like surgical procedures, mistakes during surgery of your training, lessons learnt, and tips, first operation done solo, memorable operations, memorable patients, jokes. I also accept patient posts.

You can send me your article via:

Blog Carnival Submission Form
Regular e-mail to: j o n m i k e l ( AT ) g m a i l . c o m.

Hemorrhoidal prolapse & PPH procedure

This is a case of a 67 years old male with history of chronic constipation (20 years) and chronic hemorrhoidal disease came to the office with rectal bleeding and a non-redicible anal mass.

On physical examination we found Grade IV hemorrhoidal disease.

hemorrhoidal prolapse

We decide to perform a PPH procedure with an hemorrhoidal circular stapler (33 mm) kit.

Note the tissue removed.

This donut confirms the circular and complete resection of the defect.

On the postoperatory period the patient was in excellent condition without pain and without bleeding.

Pancreatic neoplasm

A previously healthy 27 years old female came to the emergency department with a chief complaint of one-month diffuse and intermitent abdominal pain, transitory relief with bowel movements, nausea without vomit, early saciety, postprandial fullness and weight loss of 4 kilos in 1 month.

On the physical exam, we found a 10×15 cm tumor in the left upper quadrant. The tumor is not fixed, it feels solid and well delimited. We did not find any other important data.

Lab work beteween normal ranges. We ordered plain abdominal film, chest x ray and later an abdominal ultrasound and a CT scan.



CT Scan

With these findings, we decided to perform an exploratory laparotomy (left subcostal incision) and tumor resection.

Look the size of the tumor and its characteristics.

Note the splenic vein.

The tumor arises from the tail of the pancreas. It was impossible to dissect the spleen, so we had to cut it.


Final diagnosis: Benign Solid Pseudopapillary Tumor of the Pancreas of 14 cm, and 1.66Kg.

Solid-pseudopapillary tumor (SPT) of pancreas is a very rare (about 450 cases have been described in the world literature) neoplasm of low malignant potential and unknown origin. It generally occurs in young women and the prognosis is usually good after complete surgical removal.

SPT is also know as Fratz’s tumor

Bochard triad

A 68 year old female patient came to the E.D. with a chief complaint of sudden, severe epigastric pain, retching without vomitus and distention of the upper abdomen.

The patient was alert, very anxious, and in severe pain.
blood pressure of 160/120; pulse of 126; respiratory rate of 24; normal temperature; SatO2 of 96% without O2 supplement.
She had a distended upper abdomen and epigastric tenderness without rebound or guarding.

A plain film of the abdomen was ordered and showed gas-filled, grossly dilated stomach.

Pass of nasogastric tube was unsuccessful.

A laparotomy was mandatory.

The patient survived the surgery but 6 months later, she died by causes nonrelated to the surgery

In 1904, Borchardt described the classic triad of gastric volvulus: severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube.

A woman survived internal decapitation

On January 25th, a car crash took place in Nebraska and Shannon Malloy (a previously healthy 30 year old woman) was seriously injuried. Her skull became separated from her cervical spine, this is what is called internal decapitation.

“I remember the impact and then I had no control over my head… I wasn’t focused so much on the pain. I just kept thinking, ‘I have to stay alive,'” said Shannon.

5 screws were drilled into Shannon’s neck and 4 more were drilled into her head to keep it stabilized. Then a thing called a halo (rods and a circular metal bar around her head) was attached for added support. It’s not exactly a pain-free procedure.

Shannon Malloy still has a long, costly recovery ahead. A fund has been set up in Malloy’s name at Wells Fargo banks. You can make donations at any location under the “The Benefit of Shannon Malloy.”



Neurosurgery is about to change with the arrival of Neuro Arm, a new robot system developed by specialists of The Calgary University.

This device was designed by Garnette Sutherland, a neurosurgeon who worked the last 6 years to make the device that frees the surgeons of the possible faults caused by the human hand.

“Many of our microsurgery techniques come from the 60s, and have put to the surgeons the lack of the exactitude, precision, skills and resistance,” explained the professor of neurosurgery.

“Neuro Arm shows a spatial resolutions that allows neurosurgeons to operate with such precision tha we could speak of a cellular level.”

It is designed to be operated by a neurosurgeon from a workstation, the robot operates with a system of realtime images, offering a detail without precedent, and a better control of the equipment.

The surgical tests of Neuro Arm in the human patient are in process, and we hope that the first surgery with this device could be this summer,” added Sutherland.

This surgical device was designed and made in collaboration with MDA, a well-known company to participate with the NASA in the development of the robotic arm Canadarm2, used in the space shuttles. The project began in 2001, had a cost of 2 million dollars, mainly provided by B.J. and Don Seaman.

“The best surgeons can work in a space of 1/8 of inch, whereas this robot does possible to work in a space of the wide one of a hair,” explained Don Seaman.

Twin-to-Twin transfusion

Byron and Lincoln Ryman were born within a minute of each other, first Byron (3lb 6oz) was precisely three times bigger than his brother.

Eleven weeks premature, both boys were given a little chance of survival – particularly Lincoln, weighing only 1lb 2oz at birth.

But yesterday this twins, now they are five weeks old, are doing well, thanks to the dedicated staff at the Royal Hospital for Women in Sydney.


This is called twin-to-twin transfusion, where one of the blood flow of one of the babies goes from the smaller to the larger twin.

“Lincoln’s chances of survival, I considered, were less than 30 per cent because he was so small.”

But after their birth, both brothers showed an “exceptional will to live,” said Dr Mishra.

“Lincoln initially had a lot of breathing problems and then he had heart problems, so an operation was carried out when he was still about 600g (1lb 5oz).

“But Byron also needed a little bit of help with his breathing before he began to gain proper weight and now he is doing well.

“We’re now watching both boys carefully, particularly little Lincoln, but we hope that he’ll soon start gaining weight much more quickly and get nearer and nearer his brother,” said Dr. Mishra.