Wandala was grunting and holding his abdomen. He is an elder in a nearby church. He has had abdominal pain for two days. He has an IV dripping into his right arm. He lies on his side to relieve the pressure from all the bloating. I palpate his distended abdomen, which has no signs of peritonitis. He says that he had diarrhea yesterday and that he has eaten bouille (porridge) today. I get a typhoid test that is positive and hope that with treatment possible intestinal inflammation will resolve. I also place a nasogastric tube.
The next day is our “day off”. Which essentially means that we don’t make rounds and they call us less often. This day it means that we have a few calls that we take care of in their carnet (little medical record) then Jacques calls about 10AM and says I need to see a child. He has had also had a distended abdomen for two days. This one has a small hard mass at the umbilicus. A strangulated umbilical hernia. I ask them to get him ready. I see a few other patients the nurses ask me to see. Then to the OR.
I open up under the hernia. As I get into the abdomen cloudy fluid comes out. As I inspect the bowl from the small opening I see a black area. After pulling this out, I see that it is a necrotic piece of bowl, Richter’s hernia. I resect the dead area and go about making the anastomosis. As there are no staplers here, I do a hand-sewn anastomosis that takes some time. I write my note and leave the OR, I examine Wandala again, he says he feels better and has passed a little gas. I do a few ultrasounds before returning home. Audrey is sewing OR masks and hats and table drapes.
Today Audrey is helping out with the nationwide polio vaccination. She is climbing mountains looking for vaccination teams. She is to evaluate whether or not they are maintaining the vaccines in a cooler properly, filling out the paperwork for the vaccinated kids, and marking the houses of the families vaccinated correctly. I go in the hospital at 7AM, before morning worship, to evaluate Wandala. He is still very distended. Says he had a stool last night. He does not really appear to be improving.
The blade slides through the skin, then fascia. Intestines burst from their entrapment. They are very dilated. There is a twisted area of sigmoid volvulus that has blocked off the bowl. Fortunately for him, none is necrotic. I decide to close and await another day to prep him properly and resect the redundant bowl.
As I step outside to head to my office to see outpatients, it’s cooler today, 102F. I dread what it will be at the end of March. HOT! Greg
Shanksteps #149