A timely supra-major surgery by doctors at Mumbai’s Wockhardt Hospital saved the life of 54-year-old Covid positive patient who also has pancreatic cancer.
Earlier, the patient had undergone a procedure called endoscopic biliary stenting, which was done to open the blocked bile duct (tube).
The stent, which was placed to help flow of his bile duct, got blocked itself. This resulted in infection and his health worsened further.
Dr Imran Shaikh, Consultant Surgical Gastro, and GI Oncosurgery, Wockhardt Hospital said, “His condition was not good when he first came to me in June. He had jaundice. An immediate blood test of hemogram and liver function test confirmed that his stent was blocked and having infection in the biliary system.”
“CT scan of the abdomen was done to rule out metastasis of cancer. He was immediately given antibiotic treatment on an OPD basis. Then, the patient was scheduled for surgery. Before the surgery, while evaluating his Covid test turned out to be positive.”
“This was a big setback for the patient and us too. There was a dilemma that if we postpone surgery due to Covid infection then definitely he needs to repeat ERCP and repeat stenting due to stent block and infection,” he added.
“Also, there was a risk that in waiting time cancer may advance and go out of hand as he has already wasted two months before he reached
us. Also, he had monitory issues considering the cost of repeat stenting, poor background and sole earning member,” informed Dr Shaikh.
Dr Shaikh further informed that there was a dilemma to perform major surgery on him while he was Covid positive. This surgery had an inherent risk of complication (around 10%-15%) with a small risk of mortality.
“But considering Covid positive status this patient carries a very high risk of complication and death. All this due risk was explained to the patient’s wife and daughter in great detail and consent for surgery was obtained,” he added.
Dr Shaikh said that supra-major surgery was done in the specially designed negative pressure OT (designed for Covid positive cases) wherein the head of the pancreas were removed.
A part of the small intestine, part of the stomach and gallbladder with the bile duct were also removed.
After surgery, three major critical anastomoses were also done. The small intestine was used to make anastomosis with Pancreas (Pancreato-jejunostomy), with the bile duct (Hepatico- jejunostomy)and with the stomach ( Gastro-jejunostomy).
The patient was in Covid ward and post-operatively shifted to the Covid ICU.
The patient went into the Covid storm on the fifth day post-operatively. Infection flared up and he got pneumonia as there was lung involvement.
It is an acute fluid infection spreading in the body. He was on Noninvasive ventilation (NIV) for five days. And also he was administered higher antibiotics with steroids. After seven days of Covid ICU stays he was shifted to the Covid ward. He was discharged on postoperative twelfth day.
Not tackling cancer would have led cancer to spread and as well would have cost him a lot out of other non-curative temporary options like stenting and antibiotics.
He is in regular follow up and all his sutures are out. He is on a full diet and resumed his daily routine.