A Long Day of Surgery

This little skinny guy with a large abdominal mass came to me after going to a doctor in the city who sent him for a CT scan at the French Modern Hospital. The impression was a nephroblastoma or a Wilm’s tumor. I planned to spend about three hours removing it but found instead a large, cystic mass of the liver. It was not

I planned to spend about three hours removing it but found instead a large, cystic mass of the liver. It was not resectable (able to be removed by surgery). Sad case.

The next case today was a 70-year-old man with jaundice and an ultrasound that diagnosed a biliary tract stone. I had concerns it might be something worse. We don’t have great instruments for a common duct procedure. Anyway, we found the obstruction was from pancreatic carcinoma (clinical impression).

The next case was a 57-year-old educated teacher who had classical gallbladder disease symptoms. Her ultrasound showed two stones “in the biliary system.” I found her gallbladder thickened but could not palpate stones. I removed the gallbladder and opened it, and there were, indeed, two small stones impacted in the cystic duct.

So local imaging experts got a 33:3 % score today.

Advanced malignancy is much more common than gallbladder disease here. Doing a cholecystectomy (surgical removal of the gallbladder) under Ketamine (a synthetic nonbarbiturate general anesthetic) can be a real battle with no control of the airway nor muscle relaxant.

We should have “proper general anesthesia”  here within two years as we are sending one of our English speaking nurses to Kenya for formal training. Another nurse follows him next year.

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