Chad 2022 #4
Have you ever heard of the proverbial taking a load off your back expression? I saw it teenage boy yesterday with a significant load on his back. He was born with a little red nodule on his back. Apparently at the age of five he developed a growing mass on his back. It has there since then and has gradually gotten bigger and bigger. It has leaks clear fluid at times. He denies any pus coming out of it or any blood. He says it weaps the liquid at the bottom of this thing on his back. I evaluated him sitting on the bench and as he sits on the bench the mass trails off behind him. I’ve never seen anything like this. Have you? Look at the picture below. He was sent up to the capital Ndjamena last week to get a CAT scan to figure out what this was. Instead, whoever he saw ordered lab work and did not get a cat. Since they did not know what they needed, they did a lab work and came back with it. They were ready to have the operation. Unfortunately they did not get a CAT scan. Any of you who are medical, I would be happy to have your guesses as to what it is! It seems firm to the touch has some large vessels in it. It is very sad to see things like this. I hope that it is not attached to his spinal cord like a meningomyelocele.
One of the interesting operations I did was a woman who gave birth a week or so ago to a baby and then developed abdominal pain. She came to the hospital for abdominal pain. She was a evaluated by Dr. Andrew and thought that she should be operated on. He thought that she probably had an intestinal perforation. So he brought her to the operating room first thing and we operated on her together. We opened her up and she had a lot of stool throughout her abdomen. Everything was stuck; intestine attached to intestine and Intestines to the abdominal wall. Poop everywhere! This woman didn’t look as sick as she actually was. As we dissected out the various parts of the intestine, some holes were made in the serosa (covering of the intestines). It was a disaster. There were two pieces of intestine that had died and completely gone to mush. There was a large hole where the live intestine was open and then a space of white nothingness, and then the other hole where the other piece continued. And there were two sections like this. I have no idea how long it takes to look that way, but im very surprised she is still alive to get here. Eventually we found and dissected out all the small intestine and emptied all the pockets of poop and pus. She had obvious areas where intestine was ulcerated and doing poorly. We connected things back together after taking out the bad pieces and hand suturing them back together. We considered bringing out an ostomy and decided that would give her short intestine syndrome. While we are working on her abdomen. She has two rotten teeth that need to come out and have given her a rooten tooth and abscess and mandible. So as we are working on the abdomen the visiting anesthesiologist and local anesthetist get the dental tools and pry and take out two molars that are deeply impacted and one is broken off at the gum line. Today, she says her teeth dont hurt her any more! Apparently today she passed some gas. Which is a good, but I’m not sure I believe it yet as the sign the intestines are working.
God please heal her!
