Case Studies

A team of surgeons at Indraprastha Apollo led by Dr. Noor ul din Malik, Senior Consultant, ENT (Surgery), Indraprastha Apollo Hospital successfully performed an endoscopic surgery on a 14 year old boy who had developed a rare tumour (Juvenile Angiofibroma-JA) on his nostrils that was protruding on the external side of his nose. This kind of tumour is extremely rare and even the process of its surgical removal can be life threatening considering its location. The child was admitted to Indraprastha Apollo Hospital, with complains of a progressively growing tumour on the nostril due to which he was unable to breathe properly.

“This is a rare tumour found only in young boys as it occurs only in adolescent males, male hormones can be attributed to the development of the tumor.  In earlier years, external approaches were used for its removal but now endoscopy is the standard treatment. In this case, endoscopic approach was difficult owing to the location of the tumor as there was no space and the tumour was protruding out of the external nares. We took the challenge and went ahead with endoscopic approach using a technique called segmentalisation of tumour through which we were able to remove it completely without any external scar and without a pre-operative embolization. The procedure was a success and the patient was discharged within 3 days of the surgery on 28^th January, 2021.” said Dr. Noor ul din Malik, Senior Consultant, ENT (Surgery), Indraprastha Apollo Hospital

Majorly reported in young adolescent males, Juvenile angiofibroma (JA) is a rare benign, locally aggressive vascular tumour of the nose. The management of this tumour is challenging because any surgical intervention can cause excessive blood loss as this tumour is located at the complex anatomy of the nose base. Out of all head and neck cancers, 0.05% account for Angiofibroma.

A team of doctors in Mumbai Hospital gave a fresh lease of life to a 10-year-old girl who had accidentally swallowed a large metallic pin with a sharp end, 2 years ago. A team led by ENT doctors Dr Kshitij Shah and Dr Shalaka Dighe, ably supported by pediatric pulmonologist Dr Sagar Warankar and anaesthesia team led by Dr Pramod Kale performed a successful surgery at the hospital. The patient recovered and was discharged within 48 hours.

2 years ago, Naira Shah (name changed), a 10 –year-old girl from Mumbai accidentally swallowed a metallic pin. An x-ray of the abdomen was done and it failed to reveal the foreign body and everybody eventually forgot about the incident. Her life was smooth until the patient started complaining of dry cough after 1.5 years of sleeping in certain positions. Hence, the patient visited Zen Multispeciality Hospital for further investigations.

“To our utter surprise, an x-ray of the chest revealed a metallic foreign body in the lower airway on the left side. A CT scan of the chest was done to precisely locate the foreign body. After an initial attempt at removal of the foreign body by flexible bronchoscopy, a decision was made to perform a rigid bronchoscopy.” said Dr Kshitij Shah, ENT Surgeon, Zen Multispeciality Hospital, Mumbai

Dr Shalaka Dighe, ENT Surgeon, Zen Multispeciality Hospital, Mumbai, said, “Rigid bronchoscopy is a procedure done to gain access to the patient’s airway using a hollow metallic tube under general anaesthesia. The foreign body was successfully removed without any complications and without an external scar on the body after an hour-long surgery.

 “The child was hale and hearty in a couple of hours after surgery. Failure to remove the foreign body via bronchoscopy would mean a very morbid open surgery (thoracotomy) to remove it.” said, Dr Dighe

“For over 1.5 years, Naira (name changed) was fine and did not encounter any problems. But suddenly she started coughing. We panicked, feared Covid and took her to Zen Hospital. We are thankful to Zen Hospital for promptly treating our child and urge other parents like us to keep away sharp or metallic objects like pins or coins from their children,” concluded the patient’s father Sanjiv Shah (name changed).

New Delhi – A 36 years old Inderpal while working in a factory in Prahaladpur Industrial Area, Badli, New Delhi , suddenly a heavy object from the machine fell on his hand and his left forearm got crushed and amputated. He suffered from severe pain , loss of blood and went into the shock. Immediately after the injury he was taken to the hospital for treatment that saved his amputated hand.

“Though the patient reached us well within the golden time period (usually 3 to 4 hours over ice in forearm level injury), it was challenging as the forearm at the time of amputation got badly pulled and crushed. This led to multiple level injuries to the various structures (bone, muscles, nerves and vessels), necessitating a holistic approach requiring extensive shortening and graft usage from different parts of the body.” said Dr. Anubhav Gupta, Senior Consultant, Department of Plastic and Reconstructive Surgery, Sir Ganga Ram Hospital

“The latest surgical techniques it is now possible to re-join even the worst amputated limbs if they are brought in time and well preserved in ice. It is important to understand that the amputated part should not be in direct contact of ice. It should be kept in a clean polythene over ice.” Dr. Anubhav Gupta further explained

Due to the severity of the injury, it took us over 6 hours to perform the implantation of the forearm using micro-vascular technique. By 12 midnight the patient was wheeled out form the operation theatre.

At present the patient’s hand has been successfully salvaged and he hopes to have a good hand functional recovery.

Mumbai – A 42-year-old man rushed into the hospital with half of his left thumb completely cut and separated. The patient got an injury while he was cleaning the chain of his motor-bike, during cleaning the motor-bike his thumb was accidentally got amputated. The team of doctors reattached his thumb by performing microvascular surgery and reattached the chopped-off portion of the patient’s thumb.

“Rohan’s case is not an isolated incident. We get several cases of youngsters or bike enthusiasts who come for finger crush injuries, total or near-total amputations owing to bike chain related accidents. If people manage to preserve the amputated part and reach the hospital on time, we can reconstruct the digits or re-attach the detached fingers with the help of microvascular surgery.” said Dr. Nilesh G Satbhai, Head of Department – Plastic, Hand & Reconstructive Microsurgery and Transplant Surgery, Global Hospitals, Mumbai

“All the important structures were dissected, identified, and prepared on both the patient side and the amputated part. The bones were fixed using a stainless-steel wire.  The blood vessels of the thumb (artery and veins) were then connected to each other to restore the blood circulation of the amputated part of the thumb. The blood vessels at this level are very tiny (often less than 1 mm in diameter). The threads (sutures) required to join these blood vessels are much thinner than human hair and are barely visible to naked eyes. Hence, such procedures can only be performed under the operating microscope. The nerves and tendons were then repaired. Reconstructive Microsurgery aims to restore the normal form and function of the body part to its maximum extent”, Dr. Nilesh Satbhai added

The pateint name is Rohan Ajgaonkar he is a resident of Vile Parle, a banker by profession, is an adventure enthusiast. He is passionate about riding and he usually ensures himself, that his bike is well maintained. Cleaning and lubricating the chain of his bike had been a part of his regular vehicle maintenance routine.

“During the bi-monthly cleaning of my bike which I do myself, I had my bike’s engine on. This resulted in the cleaning cloth getting stuck in the chain. As I tried to pull the cloth out my finger got trapped as well. I was stunned by the pain and sight of blood. However, on the ground, I saw the part of the thumb that had been cut off. A timely surgery performed by the hospital saved my thumb. I am thankful to the doctors who helped restore my quality of life this New Year. I advise bike lovers like me to be cautious while cleaning their vehicles or get it done from a professional,” said Rohan Ajgaonkar pointing out the risks untrained hands take when cleaning their vehicles.

The patient was monitored closely over the next week to ensure that the replanted thumb remained viable. Having recovered without any complications he was discharged after 1 week.