A 9 year old male who is a school going student came with C/O left loin pain since 2 months, intermittent episodes of pain abdomen (about 2-3days of pain per week).
C/o decreased urine output, with dribbling of urine, thin & poor stream, with post void residue + (not relieved completely).
C/o fever, moderate grade, intermittent, about 1 ep in a week.
H/o nausea +, Decreased appetite+.
Patient was apparently asymptomatic 6 years, 3 months back then the patient's attenders started noticing increased abdominal girth and distended abdomen when the patient was just 3 years old i.e, approximately around Jan/Feb/March - 2018. The child was born on 25/02/2015. He appeared healthy at birth.
APRIL 2019.
In 2019, child had episodes of pain abdomen for which he was advised USG abdomen - incidentally it was found that the child had solitary kidney.
In 2019, he was taken to Urologist in West Bengal, who apparently informed the attenders about the child's condition (and allegedly told them that ~75% of kidney was damaged).
Then the urologist from West Bengal referred his patient to this hospital to provide best possible treatment.
He then came to this hospital on 23/05/2019.
Then, patient was admitted, evaluated, and was treated for 4 months.
The following surgeries were done during this 4 months of hospital stay.
Surgeries with date of operations:
1.NEPHROSTOMY - 27/5/2019
2.POSTERIOR URETHRAL VALVE FULGURATION - 12/6/2019
3.LEFT UTERINE RE-IMPLANTATION and DJ STENT INSERTION - 25/6/2019
4.URETEROLYSIS - 17/09/2019
OPERATION RECORD:
1.POSTERIOR URETHRAL VALVE FULGURATION - 12/6/2019
2. UTEROSCOPY + DJ STENT - 23-07-2019
3.URETEROLYSIS - 17-09-2019
SITES DEMONSTRATED AS SURGICAL SCARS
4. PRE - OP. IVU X- RAY FROM 2019.
IVU X- RAY FROM 2019.
IT WAS INITIALLY REPORTED AS A DISTAL OBSTRUCTION IN THE DISCHARGE SUMMARY, WHICH IS DATED SEPTEMBER 28, 2019 (DISCHARGE DATE: 28-09-2019).
HOWEVER A CLOSER EXAMINATION SUGGEST'S THAT THE OBSTRUCTION IS NEAR PUJ???, WHICH MAKES IT VERY CLEAR THAT IT'S NOT A DISTAL OBSTRUCTION
FURTHER EVALUATION REQUIRED.
Date of discharge : 28/09/2019
Then the patient was discharged on 28/09/2019 with the following ADVICE:
Normal diet
TAB.SPORIDEX 125mg TID FOR 15 DAYS
SYP. PCM 250mg 2ml SOS
SYP. OSTEOCALCIUM 2ml OD FOR 15 DAYS
SYP. ZINCOVIT 5ml OD FOR 15 DAYS
SYP. TONOFEREL 4ml OD FOR 15 DAYS
N/K/C/O HTN; DM; TB; ASTHMA; EPILEPSY; CAD
INVESTIGATIONS IN SEQUENCE FROM 2019 TO PRESENT DAY
ULTRASOUND OF WHOLE ABDOMEN ON 08-05-2019
S.UREA and S.CREATININE ON 10-05-2019
X RAY PART OF CHEST, ABDOMEN and PELVIS ON 23-05-2019
USG ON 23-05-2019
23-05-2019
RFT
LFT
24-05-2019
HBsAG RAPID and Anti HCV Antibodies RAPID
CBP ON 8-06-2019
SERUM ELECTROLYTES ON 19-06-2019
CBP ON 19-06-2019
CBP ON 9-7-19
RFT ON 9-7-19
CBP ON 29-07-2019
RFT ON 03-09-2019
CBP ON 03-09-2019
S.CREARININE ON 1-4-2024
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