CK Birla Hospitals RBH

RBH (Rukmani Birla Hospital) is a 230 bed multi-speciality hospital offering comprehensive in-patient and out-patient services in Jaipur. Laid on three key principles — Clinical Excellence, Ethical Conduct and a Patient Centric approach, this multi-speciality facility caters to the patients’ need and makes sure that they and their families are being well looked after by a team of efficient doctors, caring and vigilant nurses, and an organised Medical service support.
http://rbh.ckbirlahospitals.com

1. CK Birla Hospitals RBH
http://rbh.ckbirlahospitals.com
http://rbh.ckbirlahospitals.com
Outstanding ,complete surgical
removal of Hydatid cysts and
ectopic pregnancy

Jaipur, 26th September 2017: A 21 year old female from
Ganganagar presented with C/o easy fatiguability and shortness
of breath on exertion episodically since the last 2 years with an
increase in the severity of symptoms dating recently about a
week back. Investigated and diagnosed by an astute physician
locally and referred to us for surgical intervention. Detailed
investigations revealed that she had a huge Hydatid cyst
occupying the Right ventricle measuring about 8 x 6 cms and at
the same time another cyst in the right lower lobe of the liver
measuring 10×8 cms. The patient also had a 4 day prior report
of positive urinary pregnancy test which had been followed up
with serial Beta HCG levels and a Transvaginal USG, but
conceptus could not be detected. Obstetrics review at RBH
recommended follow up Beta HCG levels.
A combined team discussion involving the Dr. Budhaditya
Chakraborti from CTVS team, Dr. Vipin Jain, Laparoscopic
General surgeon, Dr. Vibha Chaturvedi, Obstetrician & Dr. Sunil
Beniwal, Cardiologist was carried out. We debated about
operating both cysts concomitantly in one sitting but in favor of
patient safety decided to stage the surgery taking care of the

2. CK Birla Hospitals RBH
http://rbh.ckbirlahospitals.com
critical cardiac pathology first. Since the cardiac presentation
was a potential emergency, we moved ahead with cardiac
surgery planning to follow up on the pregnancy issue
immediate post op.
Presentation in the intra cardiac right ventricular cavity bears
the potential risk of rupture causing anaphylactic reaction and
pulmonary embolism, mechanical obstruction to the right
ventricular outflow into the lungs and significant right
ventricular f ailure.
Dr. Budhaditya Chakraborti, Senior Consultation – Caridac
Surgery said “the surgery is complicated since the cyst
containing the fluid may rupture or leak while handling and is
known to cause severe fall in BP, increased airway spasm,
rashes etc. The patient was operated on cardiopulmonary
bypass and the entire cyst and its contents evacuated”. She has
had a relatively uneventful post operative course. Post
operative labs showed an increase in Beta HCG levels again and
a TV USG confirmed the suspicion of an ectopic pregnancy in
the right ovary.
5 days following her cardiac operation, the patient was
operated laparoscopically for the ectopic pregnancy and was
found to have incomplete abortion of the conceptus through
the fallopian tube. Since the patient was nulliparous, the
conceptus was recovered by milking the fallopian tube in order
to preserve her chances of a future conception. Laparoscopic
intervention for the liver cyst revealed a huge 10×8 cms cyst
which was drained and cappitonaged.
The patient had an uneventful recovery and was discharged a
day after with follow up.

3. CK Birla Hospitals RBH
http://rbh.ckbirlahospitals.com
Hyatid cysts are a parasitic infestation by a tapeworm
echinococcus. Humans are an intermediary from a primary
infestation in dogs, pigs, sheep or cattle. Exposure to food and
water contaminated by the feces of an infected definitive host
or poor hygiene in areas of infestation can lead to
echinococcosis.
Commonly reported sites of infection are the liver and lungs.
spleen, kidney, peritoneal cavity, skin and muscles is about 2%
each and incidence of the heart, brain, vertebral column,
ovaries, pancreas, gallbladder, thyroid gland, breast, and bones
involvement is about 1% each.
Such a combined surgical approach complicated by an ectopic
pregnancy is probably a first of its kind reported. Literature
search to our knowledge does not reveal any similar case.