On exam:
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| Malnourished girl with very distended abdomen, mild tenderness, something eroding from the umbilicus with surrounding cellulitis. |
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| Her ultrasound looked kind of like this...her abdomen was filled with a multicystic mass with thin walls, uterus looked normal. |
What is it? I don't know. Ovarian tumor? Mucinous cystadenoma? Omentum eroding from an umbilical hernia...or a Sister Mary Joseph node.
Mystery. I'm not sure if I love it or hate it. I suppose its a little of both. I wish I were the type of person that just loved an endless supply of the mysterious and unknown. But I'm not. Unless there is a way to find the answer. Than its fun. Otherwise, it can be stressful and hard. Especially when another person's health/life is involved.
Here was the rest of my day...notice that less than half of the patients have problems that a general surgeon would take care of in the states. Its helpful to remind myself of that- there are good reasons to feel a bit frustrated and exhausted after clinic here!
1. Man 3 months post orchiectomy with a non-healing scrotal wound.
2. follow up after tibial sequestrectomy
3. follow up after Graham patch for perforated ulcer
4. Chronic draining sinus of left thigh
5. Chronic left leg wounds
6. Left thigh abscess
7. Nonspecific abdominal and leg pain
8. Child with 12cm incisional hernia several months after laparotomy
9. Resolved abdominal pain
10. Left hip abscess
11. Urethral stricture
12. Vesicocutaneous fistula, ultrasound for possible foreign body
13. Gangrenous toes in a diabetic
14. Peritonitis
15. Follow up chest contusion
16. Palatal mass and malaria
17. Finger infection
18. Large breast mass in young woman
19. Follow up shoulder dislocation
20. Follow up 20% body burn
21. Impacted bladder stone
22. Follow up toe mass removal in a child
23. Follow up chest burn
24. Peritonitis
25. Severe leg cellulitis
26. Urinary concerns in a man- stricture versus prostate
27. Left knee pain
28. Huge abdominal mass in young woman
29. Stage III breast cancer
30. 3 week old foot fracture
31, 32, 33. Young men in a motorcycle crash with various arm/leg fractures and lacerations
34. Young man pelvic fracture
35. De-gloving injury to fingers four days ago
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36. Mastitis
37. Young man with testicular/epididymal mass
38. Boy with ankle abscess after an iron fell on it four days ago
and a few I forgot...there were still more people to see, but we stopped letting patients in at 6pm. There is an ocean of need here and I can only do so much. It just never seems like enough. Perhaps I just need to change my attitude...relax a bit more and try to enjoy the mysterious and stop trying to solve every mystery and treat every disease. Perhaps then I won't wear myself out. *sigh* I'm ready for the weekend.
2 comments:
Girl, you see the wildest things! i'm still waiting to hear what that other weird peri-umbilical herniated intestine turned out to be. the first thing I thought when
I saw the ultrasound was a hydatiform mole, but wouldn't the uterus have looked abnormal?
Not knowing what things are, and subsequently what to do is so frustrating for those of us with surgical minds. It defies the presentation-diagnosis-treatment algorithm. my brain is tired just reading your list of patients!!
S- Yep, its pretty wild around here. :) We're pretty sure that the per-umbilical intestine was a surgically created ileostomy that broke down b/c of malnutrition and one end prolapsed while the other retracted. Unfortunately, the child died yesterday- he was never healthy enough to operate on. :(
For the girl, at laparotomy the "cyst" cavity was densely adherent to the abdominal wall from the liver to the pelvis, was filled with mucus/yellow fibrinous stuff/and some pus (mostly where it had eroded through the umbilicus). The back wall of the cavity was densely stuck to the underlying intestine/stomach, etc. We think it was probably a huge, organized abscess from a contained typhoid perforation, appendicitis, or something. So, we cleaned it out and put in some drains. Its still a bit mysterious to me- but people here will go for days with perforated intestine before coming in to the hospital, and the surgeon here said he's similar abscesses before.
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