Tuesday, March 22, 2011

#34 The Grossest Thing

I’ve seen a lot of gross things here so far.  I deal with Lyol’s poop and pee.  Cloth diapers are not all they are cracked up to be....and lately the dogs’ poop because they are too scared to go outside.  I see poop and nasty fluid all the time.  I am an OB/GYN afterall.  Not to much can gross us out!  

When Olen said he had a Fornier’s Gangrene for me to see, I didn’t realize how awful it would be.  

“Hurry up dear!, This guy’s got crepitus into his thighs.” (when you push on the skin and it crackles because there is air under it).  “Do I need to say necrotizing fasciitis?  Would that make you come over to Urgence faster?  Every surgeon in the states would be jumping on this case like lightening!”  

Fornier’s Gangrene is a problem with men.  We don’t use the term in GYN land because women don’t have scrotums.  Necrotizing fasciitis occurs when some insult happens on the skin and flesh-eating bacteria go to town.  In this case it happens on the scrotum.  

This young Arabic man is 25 years old.  Tall, slender, and muscular.  You could smell the stench of rotting flesh from outside his urgence room.  One week before he had gone to a traditional village doctor for hemorroids.  A few days later, he noticed a small pimple on his scrotum.  It got bigger and after 4 days, he presented here, with his whole scrotum rotten.  

Off to the OR!

Samedi and I put on a protective gown, mask, and gloves.  We even poured some betadine on him and put down some sterile blue towels.  But this field was far from sterile.  The goal:  get rid of the rotten tissue and find the living tissue.

With the slightest bit of pressure I put on his scrotum, it disinigrated like mud.  I must have quite the touch!  (Olen’s even scared of me now!)  Everything liquified before my very eyes.  Samedi and I used gauze to wipe away rotten tissue.  Then we kept cutting.  His penis was spared, but we ended up taking his testicles.  His left thigh was spared, but his right thigh was far from it.  I used the scissors to fillet the skin on his thigh.   I had to keep cutting deeper into tissue because all the subcutaneous fat was liquified.  I cut down and eventually found the muscle to be nice and pink.  I had to extend about 10 cm down his thigh.  Even down right next to his rectum and up onto his abdomen.  

Samedi and I finished and when we took off our lightweight trauma gowns, we were both drenched in sweat!  It’s not so cool in our OR! even with the only air conditioner in Bere on.

We put him on our big gun antibiotics (Amp, Gent, and Flagyl) and prayed.  I was happy when he lived through the first night.  The first few days we brought him to the OR to have his dressing changed.  One huge compress (like a lap sponge) fit in one of the craters next to his rectum (before I opened it up more).  The 2nd day he was getting up to walk by himself.  His only pain meds are ibuprofen and tylenol!  This guy is a fighter!  Over the next week I cut off infected areas 2 more times to get to good tissue again.  His dressing was changed daily.  Each time he would unwrap the dressing himself and watch the dressing changes! 

After a week and a half, he wanted to know when he could go home.  I explained that it would take a long time to heal, and it would be better if we could graft his skin.  You know, since I’m the expert on skin grafts and all (Hey, I did see it one time in medical school).  We are supposed to have a French surgeon coming in another month, so I explained to the patient that if it was not infected, we may try to graft his skin then.  For now we should take it day by day and keep the area clean.  

A couple days ago (2 weeks after the first surgery), Olen said, “Hey, you sent that scrotal guy home?”


“Oh, well someone else sent him home then, they said you did.”  

So I guess he’s in the village now and coming back for dressing changes.  He is very independent and determined.  Please pray that his health continues.  

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Olen Tigo: +235 98 07 46 28
Olen Zain: +235 62 16 04 93
Danae Tigo: +235 98 07 46 27
Danae Zain: +235 62 17 04 80
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