I was surprised when I heard this on the rounds. The patient is a 70 year old case of Carcinoma lower 1/3rd of esophagus. He had undergone Transhiatal esophgectomy. On the 2nd post op day he developed surgical emphysema of the chest neck and face which was attributed to the faulty placement of chest tube. However it settled after Chest tube was repositioned.
On the 4th and 5th post operative day there was a leak from the neck anastomosis and it was amply demonstrated when water came leaking out of the neck wound.
All the sutures in the neck were promptly opened and patient advised to eat bananas . Simultaneously feeding jejunostomy was started. The fistula healed and patient went home in the 3rd week.

The bananas are supposed to keep the tract patent and prevent stricture which is inevitable but it is a cheap and easy option available.
What are your experiences

When I was in my last year of final year MBBS 10 years back, a lot of people used to ask me, what line I would like to pursue further. I honestly did not have the answer and I am sure most of us would not know. Its only after internship, after having worked in various departments that one knows what specialty is one going to follow. My suggestion is to work hard in internship, see and get a feel of working in various fields and then go about making a choice.
So what after clearing the PG exam (provided you clear it), My advise is that don’t be disheartened if you don’t get clear it in the 1st attempt. Most of the well established doctors didn’t clear it. Most of us would clear it anyway in 2-3 attempts so be patient and persistent.
I asked a young doctor at the end of her internship, what specialty is she after and she replied, “Anything except surgery, medicine, gynecology and paediatrics. Being a surgeon I could understand why. There is a lot of hardwork, nightshifts and heavy stuff involved and surgery and medicine today are considered incomplete without super specialization. The generation of today doesn’t want to spend continuous days in hospital.
So make your choice early and dont be disheartened. Write back if you have a comment

If you have Questions on surgery MCQs and want to share with others, You can add them here.

Q Most common cause of Budd Chiari syndrome in Asia is?
a) Polycythemia
b) IVC obstruction
c) Myeloproilferative disorders
d) Bechet’s disease

Answer b)
Budd Chiari syndrome is a rare cause of post sinusoidal portal hypertension. It can present as an asymtomatic presentation to fulminanat liver failure. There is thrombosis at the level of three hepatic veins at the level of Inferior Vena Cava (IVC).
In the west, the disease is associated with hypercoagulable staes such as protein C, protein S deficiency, antithrombin III deficiency, polycythemia vera, lupus anticoagulant, estrogen exposure and Bechet’s disease.

Q which of the statements regarding gastric polyps is incorrect..
a) Most common gastric polyps are hyperplastic.
b) 20% of all polyps are adenomtaous polyps
c) Endoscopic polypectomy is done for polyps which do not contain invasive cancer
d) Hyperplastic polps can harbour cancer in 2% cases.

Answer
b)
Hyperplastic polyps are the most common polyps in the stomach. They form 25-75% of all gastric polyps. Chronic Atrophic gastritis mostly are responsible for these hyperplastic polyps. They by themselves are non neoplastic but adenocarcinomas have been detected in 2% of cases. Endoscopic polypectomy is the treatment of choice.
Only 10% of all polyps in stomach are adenomatous polyps. They are mostly antral, sessile, solitary and eroded. Adenomatous polyps harbour malignancy 20% of times and endoscopic polypectomy is required in all polyps. Operative excision is required for sessile polyps more than 2cm in size, other polyps found to harbour invasive malignancy and polyps that bleed or are painful.

Q. Most common site of origin of accessory Right Hepatic artery is?

a. Superior Mesenteric artery
b. Gastroduodenal artery
c. Coeliac artery
d. Right hepatic artery

Answer (a)
An accessory or aberrant Right Hepatic artery arises from the superior mesenteric artery commonly. It has to be preserved because it may be the only source of arterial supply to the right lobe of the liver

Q. Which of the follwing is not an indication for resection of colon after endoscopic resection of adenomatious colonic polyp?

a. Lymphovascular invasion
b. Poorly differentiated adenocarcinoma
c. Cancer in the upper 1/3rd of the submucosa
d. Cancer with in 2mm of resected margin

Answer
c) Malignant polyp is one in which the cancer has invaded beyond muscularis mucosa. 2-12% of polyps removed endoscopically have cancers. Surgical resection of colon is required if there is lymphovascular invasion, poor differentiation, cancer with in 2mm of resected margin, invasion of lower 1/3rd of submucosa and if the lesion is flat or ulcerated.