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April 30, 2015
Event: Bariatric Surgery Support Group
Event: Bariatric Surgery Support GroupGet more info
The Department of MAS, GI and Bariatric Surgery unde
A very big thank you to Dr. Mitu Shrikhande and Dr. Pinakh, for giving me a new life.
Breakthrough Cases View All
Unchecked weight gain prompted patient to consider bariatric surgery; giant adrenal myelolipoma discovered incidentally during evaluation
55-year-old Mr. Ashwini Marwah was gaining weight for the last few years. He was also suffering from type 2 diabetes mellitus (T2DM) and hypertension. This prompted the patient to consider bariatric surgery. During evaluation and investigations by Dr Anoop Mishra, Chairman, Fortis C-DOC, he was found to have a large abdominal tumor of size 30X25cms completely occupying the right side of the abdomen and also crossing over to the left side . He was unaware of the tumour and except for causing an increase in his weight, dragging sensation and heaviness on the right side of the abdomen he was presently asymptomatic .The location of tumor was adjacent to vital organs particularly Kidney, Inferior Venacava and intestines. He was refereed to Dr Randeep Wadhawan, Director, MAS, Bariatric & GI Surgery at Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj (FHVK).
According to Dr Wadhawan – “there are increasing incidence of large adrenal myelolipoma (>10cm) presenting with life threatening and recurrent retroperitoneal hemorrhage leading to complications such as abscess and rupture. In case of Mr. Ashwini, with body mass index (BMI) of 48, diabetes Mellitus, hypertension and early changes of Nephropathy, he was a high risk candidate for surgery. He was evaluated extensively prior to surgery. We had to make a large incision on his abdomen in view of the giant size of the tumor. The tumor on removal weighed 11.5kgs, making it the largest adrenal myelolipoma ever to be excised. It was also highly vascular and attached to Right Kidney, Inferior Venacava and intestines. The biggest challenge in his case was to salvage his right kidney since his kidney functions were already affected due to his comorbidities like diabetes and hypertension. Histopathology of the tumor confirmed the diagnosis of adrenal myelolipoma. ”
The largest tumors to have been reported in India so far weighed 6 kgs and was removed in 2003. The largest adrenal adenoma, which is one the differential diagnosis for the adrenal tumors, removed in the world weighed 7.5 kgs and was removed from a patient in 2013 claiming it to be the largest adrenal tumor to have been removed before the one found inside Mr. Marwah. Adrenal myelolipoma is a very rare benign tumor, which contains mature adipose tissue and variable amounts of haematopoietic, elements. Most lesions are small and asymptomatic and discovered incidentally. It is usually small, asymptomatic and non-functional in nature with an overall incidence of 0.05-0.2%.
Mr. Abrarali Dalal, Facility Director, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj (FHVK) said, “The MAS ,Bariatric & GI Surgery team at FHVK has a very advanced and comprehensive care program intended to handle rare of the rare cases. Dr Wadhawan and his team have achieved another clinical milestone to perform a complex 4hrs surgery on morbidly obese patient to give him a new lease of life. We are grateful to our patients who have shared the stories of their recovery today. This is the best reward for us as a team.”
Mr Ashwini Marwah happily shared his experience, “I was taken by surprise when Dr Wadhawan told me that your weight gain is not due to Diabetes but due to a Giant Adrenal Tumor. Greater relief was shared by Dr Wadhawan when he told me that tumor is not harming my other organ and was removable. Post surgery I have lost more than 30kgs and now my diabetes is also under control. My recovery period post surgery has been very comfortable and thanks to Dr Wadhawan and his team to give me a new and healthy life.”
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- Reported BMI of patient was 75.8 during the time of admission
- Patient was brought in with co-morbidities – Depression, Diabetes Mellitus, Hypertension & Chronic Obstructive Pulmonary Disease
New Delhi, 21st Feb 2018:For 52-year-old Anju Chowdhary losing weight had been a concern for all her life. It had led to depression, hypertension, chronic obstructive pulmonary disease and diabetes mellitus over the years. She had tried to introduce radical lifestyle changes by exercising diet and portion control along with routine exercise. However, the results often took time, weakening her resolve. Her condition deteriorated steadily and eventually she reached a weight of 200 kilos, with a body mass index of 75.8 (obesity is a BMI greater than or equal to 30). Anju was brought to Fortis Flt Lt Rajan Dhall Hospital at Vasant Kunj as she was finding it difficult to function in her in her daily life and was unable to walk or breathe properly. A multi – disciplinary team of doctors led by Dr. Randeep Wadhawan, Director, MAS, Bariatric & GI Surgery Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj was assembled to perform a lifesaving bariatric surgery on the patient.
The operation lasted for five hours. Six doctors from various disciplines (pulmonology, cardiology, endocrinology and anaesthesia) worked together to ensure the surgery went off smoothly. Her procedure resulted in the loss of over 30 kilos. The surgery was not without challenges. Specialised operation tables and equipment had to be arranged. Reaching the point of incision under the layers of fat was a challenge. Time management was essential as the anaesthesia administered to the patient was the same that would have been administered to a lean patient. Immediately after the surgery the patient was put onto a ventilator. Post operation period was free of any complications; however the patient was put on oxygen support. This continued for a week after she was discharged as well.
According to Dr. Randeep Wadhawan, “Operating on an obese patient presents its own complexities. This is why several tests had to be conducted and the patient had to be put under observation. Navigating through the layers of fat to ensure that the incision point was properly identified had to be done in a timely manner. Once the operation was conducted we noticed that the patient’s body was responding well. Movement became possible and easier. The patient was feeling lighter. Had we not conducted the surgery, it could have left the patient bed ridden for life. Currently we look at her being able to lose 100 kilos in the next 18 months and lead a healthier life.”
Mr. Sandeep Guduru, Facility Director, Fortis Ft. Lt. Rajan Dhall Hospital, Vasant Kunj said, “The team, which was able to successfully conduct this surgery adopted a very advanced and comprehensive approach to tackle this case. They have given the patient a second chance at life and I am happy to report that she is doing extremely well. From not being able to walk at all, she is now able to take the staircase.”
Interacting with media persons, said Anju, “The more I tried to lose weight, the more I seemed to gain. I couldn’t move and I had no life outside the four walls of my room. I would stay at home and refuse to meet people or attend social gatherings. I began feeling overwhelmed as I did not know how to tackle my weight gain. I was not able to envision a better or happier life for myself. Finally when the decision to undergo bariatric surgery was taken I felt a ray of hope. The surgical procedure was smooth without many complications. Now that I have been given a second chance I will live healthy and continue losing weight.”
According to the WHO, obesity has tripled since 1975. As of 2016, more than 1.9 billion adults were overweight out of which over 650 million were obese. Out of the 39% of adults who were overweight/obese in 2016, 30% were men and 40% were women. People are considered overweight if their body mass index is greater than or equal to 25. A person is obese if their body mass index is greater than or equal to 30.