Case #50: A surgical scar


This elderly gentleman underwent a surgical procedure.

Here is a picture of his abdomen.

Photobucket

Question:
1. What surgery was performed for him?
2. What is this incision called?

Mon, 220808 @ 0700

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32 thoughts on “Case #50: A surgical scar

  1. Pingback: julie? julie… « The inner fire is the most important thing mankind possesses.

  2. ccc, it’s a little too obscene to tell u what BFS stands for but B stands for ‘big’ and S stands for ‘scar’. Got figure out the ‘F’ word yourself. :)

  3. My guess is nila = moon gal. Not sure where you got the “Gable incision”, nila, but can I have the reference. And yes, you did write ‘roof top’. Sorry for my oversight. A special ‘kudo’ for you too. :)

  4. Answers today (yesterday I didn’t have internet access)

    As suspected, surgeons are as undecided as physicians when it comes to naming their incisions. The evidences are aplenty here.

    The best answer came from lsy:

    1. Surgery on some upper abdominal viscera,most probably liver transplant. Differential diagnosis include-total gastrectomy, bilateral adrenalectomy, reparation for diaphragmatic hiatus, operations on renal??
    2. A chevron(roof top)incision-a modification of the Kocher’s incision, produced a mercedes benz scar.

    In this patient, he underwent a resection of the left lobe of the liver for focal hepatoma. The double kocher’s incision is an ideal incision to reach the upper abdominal viscera.

    The accepted answers for the incision are:

    1. Bilateral subcostal incision (when you don’t know the name of it, just describe it the best you can)
    2. Bilateral Kocher’s incision
    3. Chevron’s incision
    4. ‘Mercedes’ Incision. This one was coined by Sir Roy Calne (read here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2020659)
    5. Roof-top incision (the scar does look like a roof top)

    Unaccepted answers include:
    1. Mercedes Benz incision (Sir Roy only called it a Mercedes Incision)
    2. BFS (as given by Palmdoc ~ but I do agree that is probably the best description of the scar!) :P

    The name, Kocher’s, brings back a lot of memories, not all pleasant; particularly in my medical student days when I was forced to remember his name for all the stuff he did and invented. I first learned of this scar in India and it was named after him. You can read more about Kocher here: http://www.surgeons.org.uk/history-of-surgeons/emil-theodor-kocher.html

    So, this week’s kudos go to: FengY, little~by~little, lsy, peanut, dytia, aiesha, w1, lishun.

    Well done.

  5. 1. possible surgeries include liver resection , liver transplantation, total gastrectomy, pancreatectomy , splenectomy
    2. bilateral subcostal incision

  6. Ok Jimbo, here it goes:
    It is a bilateral subcostal (chevron/roof-top) incision with midline extension (Calne or Mercedes Benz incision. Useful in carying out liver transplantation or extensive hepatic resection.

  7. would like to try:)
    1. Surgery on some upper abdominal viscera,most probably liver transplant. Differential diagnosis include-total gastrectomy, bilateral adrenalectomy, reparation for diaphragmatic hiatus, operations on renal??
    2. A chevron(roof top)incision-a modification of the Kocher’s incision, produced a mercedes benz scar.

  8. Guys, isn’t the term ‘Mercedes Benz’ for an incision rather glamorous? I bet the incision has been around even before the car came into being. :)

    So, should we call the ‘Confrontation Method’ in assessing the III, IV and VI cranial nerves, the ‘Hyundai’ maneuver? LOL!

    And thank God no one does a ‘Proton” Incision! It would be quite ghastly to make a lion head shaped incision!

  9. i’m gonna agree with keato.

    1. transplant of the liver (just so i don’t copy completely, lol)
    2. mercedes benz incision

    thank you google and dr jimbo for the great pictures!

  10. wow this is hard!

    1. Surgery done on him. Urmm.. repair of diaphragmatic hernia or something else related to the liver, maybe a partial liver resection?

    2. I would have just said a subcostal incision but thanks to Google, I think it is called Chevron(Rooftop) incision with Mercedes Benz extension.

    Just a question, do we still use such surgical access?

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