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A critical case of an Iraqi patient suffering from upper gastrointestinal bleeding and spleen bleeding was treated satisfactorily by a team of doctors at Paras Hospitals Gurgaon. 

• A 26-year-old male, Iraqi patient presented at Paras Hospitals Gurgaon in critical stage underwent removal of his spleen and bypass (shunt) from portal to systemic circulation.
• Despite being treated at hospitals in Egypt and Iraq, his condition remained un-diagnosed since past 4 years.
• A complex splenectomy with Lienorenal shunt was conducted successfully and post-surgery the patient was discharged in 4 days.

Gurugram, 13^th  September 2017: Mr. Salam Abdulridha Zghair, a 26-year-old Iraqi patient, traveled internationally to countries like Egypt before coming to India in his quest for treatment for abdominal pain, enlarged spleen, acute weakness and inability to consume food.

In that quest, he underwent several endoscopies and numerous blood transfusions at hospitals in Iraq and Egypt, without even being correctly diagnosed.  For four long years, he continued to have unbearable abdominal pain and survived with hemoglobin levels as low as 6 g/dL and a severely low platelet count.

It was a typical example of misdiagnosed and undiagnosed case. It was only when he reached Paras Hospitals in Gurugram that he was correctly diagnosed that spleen bleeding was the main issue.

“The patient presented at our hospital in a critical stage. He had received about 14 injections of glue to stop the gastric bleeding but was devoid of any relief. Thereafter, the patient explored treatment options in India and reached Paras Hospitals Gurgaon in serious condition. Prolonged treatment without correct diagnosis had an adverse effect on his health and the condition had become worse. Four years is a long time for such ailments and it should have been correctly diagnosed and treated at an earlier stage”, said Dr. Rakesh Durkhure, Sr. Consultant General  & Laparoscopic Surgery, Paras Hospital Gurgaon.

A team of doctors and specialists attended the patient closely. Dr. Durkhure examined the patient and diagnosed spleen as the main issue along with raised pressure in his portal system which was causing gastric bleed; Dr. Rakesh Durkhure, Sr. Consultant, General and Laparoscopic Surgery led the operation along with Dr. Alok and Dr. Rajnish Monga was the gastric physician for this case.

“After diagnosis, splenectomy was conducted.  The spleen was identified and was found to be entangled in an enumerable web of blood vessels. The ligaments holding the spleen in place were dissected and the organ was removed with impunity.” Dr.Rakesh Durkhure explained.

Due to delay in proper diagnosis and prolonged incorrect line of treatment, the surgery was not without challenges.  “One of the major challenges was the 3.1 kg size of the spleen and partially destroyed vessels due to previously administered glue injections. Another big challenge was to keep blood pressure low. This was done to avoid bleeding during surgery, and to join splenic vein to left-sided kidney vein. Both these vessels were thinner than a piece of stretched see-through polythene, the thinnest that we have ever come across. Despite these challenges, including the low hemoglobin levels and platelet count, surgery was performed perfectly in 5 hours without much loss of blood.”

The case once again brings to front the importance of correct diagnosis and line of treatment. Misdiagnosis can easily lead to fatalities or serious damage to the patient’s health. In this case, thankfully, the patient had a speedy recovery and had started taking meals from the very next day.  A happy and satisfied Mr. Salam Abdulridha Zghair was discharged from the hospital within 4 days post-operation.