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Budd-Chiari Syndrome Disorder

Master X was diagnosed with Budd Chiari syndrome at age six years. He had multiple episodes of upper GI bleeding in the last 5-6 years. He had developed cirrhosis and had huge collaterals (veins that can bleed). 

 

The patient had a huge spleen reaching up to his right side. The size of the spleen was 27 cm. Due to such a large spleen, he developed symptoms of hypersplenism. like -

  • Low platelet count
  • Low Hemoglobin
  • Low white cell count

The large splenic aneurysm was a serious reason to worry. Any rupture of splenic aneurysm can be catastrophic. Because of collaterals, low platelet count, and such a big aneurysm, operating was a technical challenge.

 

Luckily, the patient was able to tolerate the surgery very well. The excision of the aneurysm and spleen went very well without any blood loss. The weight of the spleen was more than 2.5 Kg. 

 

 

 

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Rare AB+ to B+ Living Donor Liver Transplant

 

Mr. Gajanan Thamke visited Dr. Gaurav Gupta with symptoms of coagulopathy and ascites. After diagnosis, Dr. Gaurav and his team concluded that Mr. Gajanan has Non-alcoholic steatohepatitis (NASH) and he would require an immediate liver transplant. The patient’s blood group was B+, so liver donation can only be done by family members with a B+ or O+ blood group. 

 

Unfortunately, none of the family members of Mr. Gajanan suited the blood group requirement. Dr. Gaurav and his team decided to wait in case a suitable liver donor could be found. However, time was running out for Mr. Gajanan, his condition was getting worse. He needed frequent ascitic tapping and his kidney was getting injured.

 

Dr. Gaurav Gupta and his team had a frank discussion with Mr. Gajanan and his family stating that there was not much time left and he required a liver transplant urgently. The team discussed with patient about possibility of ABO incompatible liver transplant, where transplant is performed from any blood group donor. The patient’s 23 year old daughter - Ms. Jayshree had an AB+ blood group which was incompatible. After some CT scans and tests, Jayshree was found suitable for the liver transplant. 

 

So, Dr. Gaurav decided to proceed with utmost precaution as such transplants are at a risk of developing biliary complications. The doctor decided to modify the surgical procedure by making changes in how they would cut and join the bile duct.

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9 Months Old Baby with Biliary Atresia

At a private hospital in Kolkata, the Kundu family of Raipur was blessed with a baby boy, Piyush. However, the baby was diagnosed with jaundice shortly after birth. Doctors at the hospital ran tests and determined that the baby had Biliary Atresia, a condition in which the bile ducts around and inside the liver are scarred and blocked. The doctors determined that the baby needed a liver transplant as a lifesaving procedure.

 

The family was informed about the procedure. The baby's mother agreed to a liver transplant in Mumbai, and the patient was transferred to Mulund's Fortis Hospital to the pediatric ICU. After evaluation, it was found that the patient was having jaundice and a chest infection. The baby was severely underweight and had developed liver failure signs and symptoms. The patient was cared for by a pediatric intensivist team in the PICU.

 

Antibiotics, physiotherapy, and dietary supplements were used to treat the patient over the next two weeks. Aggressive optimization was done to improve the baby's chances of a successful Liver Transplant. The patient's grandmother was examined by a team led by Dr. Gaurav Gupta, who determined that she was a good candidate for liver donation. The patient underwent a liver transplant surgery which, although demanding, went smoothly. Postoperatively baby has a smooth recovery.

 

Even though it was difficult to manage the patient as he was a baby, the concentrated efforts of Dr. Gaurav Gupta and the entire team ensured that the patient recovered smoothly without any complications.

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