A team headed by Dr Imran Shaikh, consultant Surgical Gastro, and GI Oncosurgery, Wockhardt Hospital, Mira Road, successfully performed a supra-major surgery on a 54-year-old Orissa man to manage pancreatic cancer in Covid infection at Wockhardt Hospital, Mira Road amid pandemic. After spending 12 days in the hospital, the patient was united with his family. The patient is fine now and has resumed his daily routine.
54-year-old Arvind Ojha from Bhubaneswar who is working in the office, In April 2021 experienced symptoms of weight loss, loss of appetite, And generalised weakness. He was unable to perform his daily activities with ease. He lost around 10 kgs. His worried family members took him to the local doctor who prescribed some medicines but he failed to get that much-needed relief. Then, he consulted a doctor in the city hospital who carried out an investigation and it was revealed that he had cancer of the head of the pancreas.
Since it was the second wave of the Covid pandemic and all the surgeries were put on hold, a procedure called endoscopic biliary stenting was done to open the blocked bile duct (tube). A stent that is a small plastic or metal tube to open the bile duct is placed into the blocked bile duct. Bile (fluid from your liver) helps one digest fat and other foods that you eat. The flow of bile can be blocked by tumours (cancers) or gallstones of the bile duct. The stent helps widen the narrowed area of your bile duct and allows the bile to flow through. This procedure will reduce the symptoms such as jaundice like yellow skin. Unfortunately, the stent placed was got a block and developed an infection in the biliary system. The patient’s health deteriorated even after this procedure and decided to take treatment in Mumbai. He along with his family travelled to Mumbai along with medical reports. After coming to Mumbai, the patient was refused treatment at various hospitals owing to his critical status. However, the patient approached Wockhardt Hospital, Mira Road wherein Dr Imran Shaikh saved his life.
Dr Imran Shaikh, consultant Surgical Gastro, and GI Oncosurgery, Wockhardt Hospital, Mira Road said, “On arrival in June to OPD, his condition was not good. He looked emaciated and frail. He had jaundice. On 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 an antibiotic treatment on an OPD basis. The patient suffered from pancreatic cancer. The pancreas releases enzymes that aid digestion and produce hormones that help manage your blood sugar. Pancreatic cancer begins in the tissues of the pancreas which is an organ in the abdomen that lies behind the lower part of your stomach. Normally we do not know the exact cause of pancreatic cancer. However, some risk factors like smoking, alcohol consumption, obesity, chronic pancreatitis, Diabetes are associated with cancers. More than 300 patients have been operated in lockdown, out of which almost 30% were GI cancers. Then, the patient was planned for surgery in June 2021. Before the surgery, while evaluating his Covid test turned out to be positive. This was a big setback for the patient and us too. Most of the Centre’s refused surgery in view of Covid infection and advised to wait till the Covid test become negative. There was a dilemma, If we postpone surgery due to Covid infection then definitely he needs repeat ERCP and repeats stenting due to stent block and infection. Also, there was a risk that in waiting time cancer may advance and go out of hand as he has already wasted 2 months before he reaches us. Also, he had monitory issues considering the cost of repeat stenting, poor background, sole earning member, no place to stay in Mumbai. This all would cost him a lot. Another dilemma was to perform major surgery on him while he is Covid positive. This surgery has 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.
Dr Imran Shaikh added, “The Supra-major surgery was done in the specially designed negative pressure OT (designed for Covid positive cases) wherein the head of the pancreas should be removed. A part of the small intestine, part of the stomach and gallbladder with the bile duct were also removed. After surgery, 3 major critical anastomoses were 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). Surgery was difficult due to his infection, long-term jaundice, and stenting. The surgery lasted for 6 hours and the blood loss was minimal. The patient was in Covid ward and post-operatively shifted to the Covid ICU.”
Owing to Covid, the patient went into the Covid storm on day 5 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 5 days And also needed higher antibiotics with steroids. After 7 days of Covid ICU stays he was shifted to the Covid ward. He was discharged on postoperative 12 Th days. 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 his all sutures are out. He is on a full diet and resumed his daily routine. He went back to Orissa where he is recuperating’’ said, Dr Imran.
“My world turned upside-down after I suffered from jaundice and lost a lot of weight. To my dismay, I was diagnosed with pancreatic cancer. I was shocked after I saw my report and was numb. I thought my condition will never improve as many hospitals refused to operate as my health kept deteriorating. Things turned awry when I turned out to be Covid positive. But, I was fortunate to be able to seek prompt treatment at Wockhardt Hospital. I thank the doctors for giving me a second lease of life. I urge you all to take charge of your health and do not ignore any abnormal symptoms seen in the body, Try to seek treatment as soon as possible. Avoid delaying treatment during the lockdown as you can land in trouble. I am happy to be back on track and have gained weight now, can eat properly, and do my real-world activities with ease, “concluded patient Ojha.