Another day....another 10 francs

Back to the "gory" medical stories. Today I did a bit of catch-up and operated on three patients that we didn't get to last week because we were so busy. 

I started with an anal fistula. But it wasn't just any anal fistula. It was high. The highest I've ever seen. I could barely reach the internal opening with my finger. She was the perfect candidate for fibrin glue. But we don't have that here. And we don't have fistula plugs.  So, I did the next best thing...I made my own fistula plug out of some Surgisis we happened to have.  Check.

Next, I excised a recurrent foot mass. Poor guy had waited all day Wednesday and Thursday and Friday. Then, he waited all weekend. We just had too many emergencies. But he didn't complain.  It was a mass with yellow granules...maybe a mycetoma?  Not sure....we'll see what the pathology shows.

Then came the exploratory laparotomy for an abdominal mass. I saw her in clinic. A young woman with a mildly tender, mobile right lower quadrant mass. I did an ultrasound and saw a mass, but couldn't really tell what it was. So, the next step was to explore. 

So, I opened here up and found a kind of cystic mass coming from the terminal ileum with bowel going in and bowel going out and the mesentery all scarred down and short. So, I took it out. It took a while with all the scarring and the unique challenges of operating here. 

Like, when I was a resident, for any major surgery there was usually an attending, a senior resident, a junior resident, a scrub tech...and a self-retracting system that could hold several retractors in place.  Here, it is usually just me,an assistant/scrub tech, and, perhaps, a Balfour retractor.  It takes some creativity and patience.   And as I'm working along and the power goes out... I hear my attendings' voices in my head telling me that surgery requires "perfect tension and perfect vision" or "the most important part of an operation is exposure." And I wonder what they would say if they saw me now.... I do my best...I count to three and the generator comes on and we keep going. Things take a bit longer to accomplish, with a bit more effort...but it gets done.

I took out the mass and reconnected the bowel (oh...did I mention that I miss staplers?).  Then, I cut it open on the back table. This is what I found:

Turns out it was some sort of inflammatory mass...I cut it open and it contained loops of small bowel. She should do well.

Then, I got a call that we had a kid in clinic who swallowed a coin yesterday and was having  trouble swallowing.

The x-ray

Well, "normally" I would call the pediatric gastroenterologist...but here, that's me!. So, we intubated and anesthetized him and then I put a Foley catheter down his esophagus, inflated the balloon, and pulled. Voila!  There in back of his mouth was 10 francs! Yay!

the coin...worth about 2 pennies (yes, we gave it back to the father)