Fortis Hospital Anandapur, Kolkata

Fortis Hospital, Anandapur, Kolkata is a world-class super-speciality NABH accredited tertiary care healthcare hospital. The 10-storied, 400 bed hospital is built on a 3 lakh square feet area, equipped with the latest technologies in the medical world. This state-of-the-art facility specialises in cardiology and cardiac surgery, urology, nephrology, neurosciences, orthopaedics, digestive care, emergency care and critical care. Among the various amenities, the hospital has a 24-hour accident and emergency service including trauma treatment, critical care ambulance service, blood bank, cardiac operation theatre, preventive health check, diagnostic and catheterisation laboratory, critical and emergency care, diet counselling, physiotherapy and rehabilitation, laboratory and microbiological services, stress management, 24x7 pharmacy, endoscopy unit and emergency room.

The intensive care unit (ICU) is well-equipped with over 70 beds that include a Medical Intensive Care Unit (MIC

Fortis Hospital, Anandapur, Kolkata is a world-class super-speciality NABH accredited tertiary care healthcare hospital. The 10-storied, 400 bed hospital is built on a 3 lakh square feet area, equipped with the latest technologies in the medical world. This state-of-the-art facility specialises in cardiology and cardiac surgery, urology, nephrology, neurosciences, orthopaedics, digestive care, emergency care and critical care. Among the various amenities, the hospital has a 24-hour accident and emergency service including trauma treatment, critical care ambulance service, blood bank, cardiac operation theatre, preventive health check, diagnostic and catheterisation laboratory, critical and emergency care, diet counselling, physiotherapy and rehabilitation, laboratory and microbiological services, stress management, 24x7 pharmacy, endoscopy unit and emergency room.

The intensive care unit (ICU) is well-equipped with over 70 beds that include a Medical Intensive Care Unit (MICU), Coronary Care Unit (CCU), and recovery and isolation beds, with separate high-dependency units. The hospital also has a nephrology department with over 28 advanced dialysis units. The hospital, governed by integrated Building Management System (IBMS), has a pneumatic chute system, for quick vertical and horizontal transportation between floors, facilitating speedy transfer of patient specimens, documents, reports, and medicines to the concerned departments. This saves time for rendering effective and efficient healthcare to the patients.

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    BLS Training to Bus and Auto Drivers

    On occation of the Road Safety Week, Fortis Hospital, Anandapur organized BLS Training session fo

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Medical team at Fortis Hospital Anandapur conducts EBUS on the youngest-ever child in India

The 8-year old young lad was brought to the Emergency Department in a pretty serious condition. On initial examination, the doctors noted that the patient had an oxygen saturation level of 40%, as compared to a normal saturation level of above 95%. The X-Ray and CT scan suggested that the lungs looked very inflamed, swollen and red with large glands between the heart and the lungs called mediastinal lymph nodes.

Post examination, Dr. Nicola Flynn exclaimed, “The child seems to be suffering from this condition for a minimum period of 6 months to an year, as is evident from the symptom like clubbing ie. beak-like bulbous development on the fingers. Clubbing happens gradually over a period of time and is not a sudden occurrence.”   

The team of doctors comprising pediatrician Dr. Nicola Flynn and pulmonologist Dr. Raja Dhar suspected two possibilities- firstly, a bad infection that the child’s was suffering from or an immunological condition, which may be a reaction to something that the child may have been exposed to in the past or a combination of both.

Despite all the oxygen that the child was being given, the team was having a tough time maintaining the child and was kept on non-invasive ventilator support. This made the treating team to consult with Dr. Sanjay Singh, Head of the Department of Anaesthesiology and proceed with a high-risk Endo-Bronchial Ultrasound or EBUS. EBUS is an advanced bronchoscopy, which not only goes into the breathing tubes and looks at the nodes and glands between the lungs and the heart, but one can also retrieve samples for testing through a specialized probe, similar to an ultrasound probe. There were two major challenges faced by the doctors during the EBUS in this case. As Dr. Raja Dhar mentioned, “Firstly, the probe is generally not made in accordance with the dimension of breathing tubes of children and secondly, the airway of this child was far narrower than that of a normal 8-year old. But, going ahead with and EBUS was more of a compulsion than a choice for the team.”

Finally, Dr. Dhar and his team successfully conducted the EBUS on this child. This was the first time EBUS was conducted on an 8-year old in India. During the procedure, the oxygen saturation level dropped a couple of times but was brought back to normalcy. The team managed to take plenty of samples from the glands and made sure that there is no reproaching infection there.

Post the EBUS, the treating team concluded that the patient was suffering from a condition called Acute Hypersensitivity Pneumonitis, which was more immunological than an infection. Hence, the patient was treated by administering steroids and some antibiotics to fight any hidden infections. The young patient gradually recovered and came out of Intensive Care. The oxygen requirement also came down over a period of time leading to complete weaning off of the oxygen support.

On the date of discharge, the patient’s oxygen saturation level was 95% on room air and he was moving around without any discomfort.                    

55-year old Mrs. Jahanara Begum, from Bangladesh, underwent a complicated Vesico-Vaginal Fistula Repair under Dr. Sujata Datta, Consultant Gynaecologist at Fortis Hospital Anandapur. 

The patient first visited the treating doctor with complaints of continuous urine loss vaginally for the past 20 years. On counselling, the patient disclosed that the incontinence began immediately following her last delivery, which she claimed was a difficult forcep delivery. Prior to coming to India, the patient had undergone two attempted surgical corrections without success in her native country. 

A CT urogram revealed an approximately 3mm gap in the posterior wall of urinary bladder communicating with vagina at the junction of upper and mid third of vagina. The vaginal canal was distended with extravasated contrast fluid. Uterus was present. The defect was approximately 5mm away from the right vesico-ureteric junction. The whole area was scarred and puckered due to the two previous failed surgical repairs. 

A repair would be hazardous due to the proximity of the fistula with the ureteric orifice. To add to it, the patient was frail and her general condition was poor. 

Dr. Datta planned a Right Ureteric Catherisation by cystoscopy, followed by VVF repair vaginally with a labial fat pad graft, under a combined spinal epidural anaesthesia, which would avoid the morbidity of an abdominal procedure in a frail patient. 

After a right ureteric catheterisation to prevent the ureteric orifice from being caught up in the repair, the vaginal wall, around the fistula was separated from the bladder wall, vaginally. The fistulous tract was excised vaginally and defect was closed in multiple layers. A labial fat pad was grafted between the bladder and vagina. A catheter left in situ was removed in 3 weeks. 

Following catheter removal, the patient regained full continence and was able to void normally. 

This case is special for the following reasons: 

1.       This was a rare long standing obstetric fistula (20 years), following a difficult forceps delivery, usually found in women of low socio-economic status in resource limited countries that have poor access to intra-partum care. 

More commonly, Vesico Vaginal Fistula develops after inadvertent iatrogenic bladder injury during complex hysterectomies and are identified and repaired soon after the fistula becomes apparent.  

2.       The patient had undergone two failed repairs in Bangladesh, making it a technically complex surgical case due to extensive scarring around the fistula. The fistula was very close (5mm) to the right ureteric orifice, increasing the risk of it being caught up in the repair. 

3.       As the patient was very frail, a vaginal procedure rather than an abdominal procedure helped reduce operative morbidity and allowed a quick recovery, making it possible for her to travel back to her native country, 5 days after the surgery, returning in 2 weeks for an outpatient catheter removal.  

In conclusion, this was an unusual and technically challenging case presenting at a tertiary centre, having failed 2 previous surgical repairs in Bangladesh that was successfully treated with minimal morbidity, allowing a quick 5-day recovery to a 20-year long problem.

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