Case 1:
Goh presented a 70 years old man post stapler heamorroidectomy day 4 presented with PR bleed. Hemodynamically stable, Hb 14.5. Brought to OT, EUA showed oozing at anastomotic site - figure of 8 suturing was done and bleeding stopped.
Q - "For pt with post stapler bleed, how to tackle or how far to examine in the ward or should bring them to OT instead?" - Prof Jasmi
A- "I don't have an answer how far to examine but I can assure you it is difficult to see it in the ward, better to bring to OT" - Prof Ismail
Q - "How about temponade dressing" - Prof Jasmi
A - "You can temponade it, but if active bleed it won't stop, most of the time bring to OT for suturing" -Prof Ismail
Q - "Empirical antibiotics?" - Mr Azim
A - "Flagyl" - Prof Ismail
Q - "If still bleeding?" - Mr Hanafiah
A - "Refer vascular!" - Prof Jasmi....... everybody laugh.. except surgeons from Mongolia
A - "More than 90% will stop, but if its still bleed I would packed and suture it (packed dressing)" - Prof Ismail
Case 2:
Fuad presented a man underwent lap chole 4/12 ago, presented again with obstructive jaundice signs and symptoms. US showed stone in mid portion of CBD.
Q - "Is it missed stone or primary stone?" - Prof Jasmi
Q - "How long after lap chole if develop stone define as primary stone?" - Prof Jasmi
A - "before 2 years missed stones, after 2 years primary stone" - Prof Jasmi
Q - "Difference in management?" - Prof Ismail
A - "if primary stone one has to consider chances of developing recurrent stone and also have to consider intrahepatic stone" - Prof Jasmi
Case 3:
Spontaneous DVT, no pelvic or abdominal mass. Medical refuse to take over, as usual surgical team save the day.
Q - "If pt DVT comes to A&E who will take?"
A - "DVT is a no mans land. Predict the cause of DVT, if spontaneous it goes to medical, if fracture goes to ortho" - Prof Ismail
zairul
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