PRNewswire
Ahmedabad (Gujarat) [India], July 28: Gastrointestinal conditions affect the digestive tract and can be either structural (physical abnormalities) or functional (disrupted gut-brain communication) in nature. Rarer conditions are difficult to diagnose as they remain under the guise of common symptoms. Managing these well takes a mix of advanced imaging to narrow down a diagnosis and an experienced surgical team. In Gujarat, Zydus Hospitals, Ahmedabad has carved a niche for itself in gastrointestinal care, excelling across complex treatments, surgeries, and state-of-the-art diagnostics.
In one recent case, a 28-year-old new mother came to Zydus Hospitals with persistent, crampy abdominal pain that had begun in her third trimester of pregnancy and never fully resolved even after childbirth. She recalled it feeling like something was moving inside her besides the baby. It was brushed off as mere discomfort, but when her complaint persisted 2 months post-partum, she was referred to Zydus' Gastrointestinal Surgeon, Dr. Dhaivat Vaishnav.
"Her pregnancy scans, done by her gynaecologist at another facility, hadn't picked up this mass. However, once she was referred to us, we asked her to get a CT scan right away," said Dr. Dhaivat. The scans showed a large mass near the small intestine, and the impression was that of a duplication cyst. It was the team's familiarity with exactly this kind of complexity from regularly handling patients with such complex, rare and ambiguous diagnoses that let them flag the mass and move straight to surgical planning without delay.
Intestinal duplication cysts are rare congenital malformations in which an extra, fluid-filled structure lined with gut-like tissue develops alongside the normal bowel, often sharing its blood supply. These are almost always diagnosed in adulthood or when they become large enough to cause symptoms. The cyst had grown to roughly 6 cm by the time it was detected, an increase that Dr. Dhaivat's team suspected was influenced by the hormonal shifts of pregnancy.
"Given she was barely two months post-delivery, and her surgical scars had not healed yet, we planned a robotic GI surgery to approach this in a minimally invasive way and reduce additional strain as she was still recovering from childbirth," said Dr. Dhaivat. "The mass was closely wrapped around the superior mesenteric artery and vein (SMA and SMV), which are major vessels along with several of their branches that supply blood to most of the small intestine. Using the robotic platform's magnified view, they could remove the mass completely while preserving the SMA, SMV, and all their branches. This would not have been so easy had we operated through open surgery," he added.
A sample was sent for histopathological analysis, which identified the mass as a dermoid cyst. These cysts are congenital growths that form when ectodermal tissue (ectoderm is one of the three primary germ layers in embryonic development) gets displaced during early fetal development instead of following its normal migration path. Commonly found in the ovaries, dermoid cysts can occur anywhere and are more common in women. Left undiagnosed, they carry a risk of infection, bleeding, and malignant transformation.
The patient was discharged three days after surgery and continued to recover well through her follow-up visits. Such cases, said Dr. Dhaivat, reflect a broader pattern of patients referred to Zydus's gastrointestinal surgery unit. "Our core area is complex GI surgery, tending to patients with underlying comorbidities like liver disease, compromised kidney function or other serious complications that complicate standard decision-making. Hepatobiliary and pancreatic surgery in Ahmedabad remains a particular strength for us. Cases like these need a hospital built to provide complete pre- and post-operative support at every stage alongside advanced imaging tools like endoscopic ultrasound, a 256-slice CT scanner, and 3 Tesla MRI, which help us diagnose complexities early and treat patients better," he said, adding that a dedicated liver ICU and transplant programme, backed by multidisciplinary teams on standby, lets the hospital take on cases other centres refer out. They also house Gujarat's largest endoscopy unit, offering everything from ERCP and EUS to capsule endoscopy and liver elastography under one roof.
In addition to the advanced technology, the department also has a renowned team of gastroenterologists like Dr. Nilay Mehta, Dr. Ajay Choksey, Dr. Hardik Kotecha, Dr. Tejas Modi, and Gastro-Surgery team consisting of Dr. Bhavin Patel, Dr. Dhaivat Vaishnav, Dr. Mayank Gurjar, Dr. Vismit Joshipura, Dr. Amit Shah, Dr. Suril Vithalani. They offer a full range of complex procedures from esophageal and gastric surgery in Ahmedabad to colorectal, liver, and pancreatic surgery using laparoscopic and robotic-assisted surgeries in Ahmedabad. In addition to cases like this, Zydus' GI department has also become a leading centre for treating complex GI cancers in Gujarat, and is led by Dr. Subhabrata Das and Dr. Mahesh D. Patel, GI, Lung and Thoracic Cancer Surgeon, who has performed hundreds of rare cases, several of them among the first of their kind in the country.
Whether it's complex perforation surgery, gastrointestinal bleeding surgery, or routine procedures like hernia repair, the surgical team is equally experienced in handling both the most challenging and the rarest cases. Recently, a 70-year-old breast cancer survivor from Ahmedabad, who had been hospitalised twice for emergency transfusions, and as her hemoglobin dropped to 4.0 g/dL, she was referred to Dr. Suril Vithalani, Surgical Gastroenterologist and Robotic Surgeon at Zydus Hospitals, Ahmedabad. "She was exhausted, frightened, and had no explanation for what was causing her to bleed internally," said Dr. Suril.
Given her cancer history, doctors elsewhere suspected metastasis or a new cancer, despite the clear biopsies and a PET-CT scan that showed no metabolic activity at the site. However, when Dr. Vithalani reviewed her scans, the lesion showed up as fat-density tissue, a lipoma, and as it was in the layer below the mucosa, it was diagnosed as a gastric submucosal lipoma. Statistically, standard mucosal biopsies identify the correct diagnosis in gastric submucosal lesions in only about 8% of cases.
"If there is any submucosal bulge, any unexplained anaemia, or any bleeding without a clear surface source, a PET CT scan of the abdomen must follow. That is the real lesson of this case," said Dr. Suril.
Gastric submucosal lipomas are rare, with less than 50 cases published worldwide. The risks climb sharply when it grows to 4-5 cm, as the mass starves the lining above it, leading to ulceration. The patient's lump was 5.3 cm, and it had started to push against the stomach lining from underneath, starving it of blood supply, causing ulcers to form on the surface, and eventually causing those ulcers to bleed. Of the roughly 50 reported cases worldwide, only 27 needed surgeries, making her case potentially the 28th, and among the first done robotically anywhere.
Dr. Suril performed a robotic-assisted transgastric enucleation and removed the lipoma as well as the ulcerated tissue around it. The specimen confirmed a benign, encapsulated fatty mass. "As her hemoglobin levels returned to normal, she slowly made a full recovery, " he said.
Cases like these reflect the coordinated effort behind every successful diagnosis, and surgical gastroenterology, oncology, radiology, and pathology bear results when they all work in tandem. The same coordination is seen across its centres at Zydus Vadodara by Gastroenterologists, Dr. Jatin Agarwal and Dr. Ruchir Gohil and Gastro Surgeons, Dr. Deep Patel and Dr. Nitinkumar Patel; and at Zydus Anand by Gastroenterologist, Dr. Jimmy Patel and Gastro Surgeons, Dr. Jignesh Rathod and Dr. Pratik Shah.
To know more about their services, visit https://zydushospitals.com/.
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