TYPHOID!! I’m in the operating room doing my first case of the day which is another bladder stone (I think i did three different patients with stones yesterday). Andrew did surgical rounds, and he sends the lady back to me that Ive already operated on twice for typhoid perforations. She was the one with the dead bowel in two sections. last time i operated on her i left a drain so I would know quickly if she perforated again, meaning that stool would come out the drain and tell me things were bad. So he was rounding and saw that she had a distended abdomen and that there was stool coming out the site where i had left a sterile glove finger hanging out as a drain.
I feel sad as we get her to the OR and sit her up for the spinal. Liquid yellow stool gushes from her drain and incision pooling around her then flows over the OR table side and waterfalls down to the floor making a large pool growing pool on the floor. Im guessing that more than a gallon has leaked on to the floor before the spinal anesthetic is in and she is laid back down on the operating table. One of the nurses, David, cleans up the floor and the patient and places a urinary catheter, then cleans the abdomen. in the mean time I rush back to the place we are staying to use the bathroom, then back to the OR. She was prepped with betadine and I scrub my hands at the sink and put on my cloth surgical gown. I know this will likely be wet with the patients stool down to my skin- yuck! But this is what we have to wear here. They are washable and reusable. It is 10AM and the OR temperature is already 85 deg F inside. HOT with all the surgical gab on. (It will get up to about 98 later on in the day). We pray for her and us and this operation, then I remove my previous skin stitches and take out the glove drain and open the fascia stitch. We suck out a couple more liters of liquid yellow stool out of her abdomen.
As I look around the intestines don’t seem stuck together as I expected. She must be to malnourished to be healing that fast. Not a good sign. I look and there are two small 2mm holes in the intestine about 3 inches apart from each-other. Then i find another. TYPHOID has made these holes. We’ve been treating her all along for typhoid but it appears to continue to wreak its havoc. I choose a piece of intestine to take out that includes all three holes and is about 6 inches long and cut it out. I tie all the vessels off that went to that section so they don’t bleed. Then with silk suture, I reconnect the intestine back together. It takes me about
45 minutes to hand sew this anastomosis. With staplers in the US it would take about 5-10 min. I wash out her abdomen with liters of fluid and eventually it becomes clear. There is residual stuff stuck to the intestine that wont come off. I close the fascia and leave the skin open as it will become infected if I close it.
In the other OR room Papa and Lazaar, the two fix it guys, are trying to get one of the 4 AC units in the ORs working. They replace some wires and turn it on. one runs and cools but then the electrical cord and the one feeding the plug get warm and they turn it off. We sure need a knowledgeable handyman here! There are endless things to fix.