Dr Rohit Thakur - Surgeon

“Even the smallest abdomen can hide a big surgical emergency.”

A 2-year-old child was brought to the Emergency Department at Pt. JLNGMC Chamba with severe abdominal pain, vomiting, and signs of sepsis. Evaluation revealed a perforated appendicitis — a rare but life-threatening surgical emergency at this age.

Without wasting crucial time, An emergency appendectomy was successfully performed, and the postoperative recovery remained uneventful.

Although uncommon in toddlers, appendicitis in a 2-year-old is clinically important because:-
1. Diagnosis is often delayed due to nonspecific symptoms.
2. Children cannot localize pain well.
3. It has a very high perforation rate:
Often 70–90% perforated at presentation in children under 3 years.

“Appendicitis has no age limit.”

“Small parasite, big disease.”

Today at Pt. JLNGMC Chamba, we successfully operated on a 58-year-old gentleman suffering from multiple hydatid cysts of the liver.
The patient had two cysts — one in Segment V (5×6 cm) and another large cyst in Segment VI (10×8 cm). A successful partial cystopericystectomy of both cysts was performed.

Hydatid disease is caused by a parasitic infection and commonly affects the liver. Many patients remain asymptomatic for years, while others may present with abdominal pain, swelling, fever, or complications due to rupture or infection of the cyst.

Large liver hydatid cysts can become dangerous if left untreated and may lead to serious complications.
Early diagnosis with ultrasound/CT scan and timely surgical management can prevent morbidity and save lives.

Take-home message:
1.Maintain proper hygiene
2.Wash vegetables and hands regularly
3.Deworm pet dogs periodically
4.Seek medical evaluation for persistent abdominal symptoms

Surgery, when done timely and carefully, offers excellent outcomes even in complex hydatid liver disease.

“A ‘little old lady’s hernia’ — small in name, massive in impact.”

At 82 years of age, when most would attribute abdominal pain to “just age,” she walked into our emergency with severe discomfort, vomiting, and absolute constipation.

A — rare, silent, and often missed — was the culprit. Diagnosed on CECT abdomen with obstructed obturator hernia, a life-threatening situation.

Time was critical.

She was taken up for an emergency laparotomy. Despite her age and frailty, the surgery was successful. The obstructed bowel was relieved, and the hernia repaired.

Today, she recovered well — a reminder that age is not a barrier when timely diagnosis and decisive surgical intervention come together.

In surgery, every minute matters. Every decision counts. And sometimes, even the rarest diagnoses can lead to the most rewarding outcomes.

Why known as little old lady hernia-

It typically occurs in:
Elderly women (usually >70 years)
Thin, frail, multiparous females
Due to loss of protective fat in the obturator canal.

“When a tumor grows with frightening speed, surgery must move with equal courage and precision.”

A young female patient presented with a rapidly growing lump in her left breast, which had increased to nearly 15 × 15 cm in size within just two weeks.

On clinical assessment, the possibility of a Phyllodes tumour was considered. These tumors are rare breast tumors known for their rapid growth and large size, especially in younger patients.

Considering the size and aggressive progression of the lump, the patient underwent wide local excision of the tumor with adequate margins. The surgery was performed successfully.

The final Histopathology Report (HPR) is awaited, which will confirm the exact nature of the tumor and guide further management if required.

This case highlights the importance of early medical consultation for any rapidly enlarging breast lump, as timely surgical intervention can lead to excellent outcomes.

“A perforated ulcer doesn’t wait. Neither should you.”

In the last one month, I operated on 5 patients with duodenal ulcer perforation at Pt JLNGMC Chamba.
Surprisingly, 3 of them were below 35 years of age (Youngest was 23 years old).

Traditionally, this condition is considered more common in older individuals. However, we are now seeing an increasing number of young patients presenting with this life-threatening emergency.

Why are younger patients at risk?
1.Helicobacter pylori infection
2.Frequent painkiller (NSAID) use
3.Smoking
4.Alcohol
5.Irregular food habits
6.Stress

❗ Important Message-
1. Severe sudden abdominal pain is never ‘just gas’ — especially if it doesn’t settle.
2. Duodenal Ulcer Perforation – Not Just a Disease of the Elderly.