Monday March 10

Monday March 10

        I have a miserable cold with a stuffy runny nose and a cough; this isn't a whole lot of fun when operating with a mask on etc., but our work goes on. Yuk and Rakesh reported at breakfast that our patients were doing well with no particular post-op problems. We then all went to Grand Rounds, but it was cancelled so we went to the OR for another productive day. First Yuk and I repaired a ventral hernia on Barbu's wife, and then we did a 10 month old with a hernia. In the meantime, Santiago and Rakesh did an adult hernia in the other room. After that we switched rooms so that they could do a splenectomy followed by surgery on Thomas, an 8 year old boy.
        Putting a story together based on information in the chart is an interesting and quite inexact science here. It would seem that Thomas came to the hospital last August with 3 days of abdominal pain, and a history of constipation. It is unclear to me how, but they made a diagnosis of Hirshsprung's disease, and did a colostomy. Subsequently, in November, he underwent recto-sigmoid resection and reanastomosis, but he developed an anastomotic leak and underwent another surgery to create a colostomy again. He is well now, so Santiago wanted to try to restore his intestinal continuity. We think the diagnosis of Hirshsprung's is most likely incorrect. So in the OR after a rigid sigmoidoscopy they took down the colostomy, found the rectal stump, and did an EEA anastomosis. Flying on a wing and a prayer, and hoping for the best, he decided not to do a diverting ileostomy in hopes of sparing Thomas yet another operation.
         We thought we were done for the day, but then we received word of a patient with appendicitis in the ED. This 57 year old man had a 3 day history of RLQ pain, and an exam consistent with appendicitis. The problem was that we had apparently run out of anesthetic gas. Philomina asked if we could do it under spinal, and I said I would try. We made a small RLQ incision, and immediately a lot of pus and stool came out, causing me to abandon that approach. So we made a lower midline incision, but with the patient breathing and pushing, it was impossible to do what we needed to do because he was pushing his intestines out through the incision. I looked at Philomina, and she said ok, so then she gave him a muscle relaxant and I don't know what else but we were able to complete the surgery. It turned out that he had a large cecal perforation rather than appendicitis, and I ended up doing a right hemicolectomy. I imagine the perforation was due to typhoid; I will bring a specimen home for the pathologists to tell us what they see.
      After finishing that, we went to the dorm for dinner, and then back to the apartments. I'm miserable with this cold, and would give my eye teeth for a bottle of Afrin right now !!