This one we’re going to entitle, “How to deliver a 5 year old baby by c-section.”
She came in one afternoon for an ultrasound referred by the nurses. At first notice, you would think she was pregnant. You would even think she was pregnant with a 5 year old by the way her belly protruded forward. She looked so uncomfortable.
She’s in her mid 40’s and has 4 living children. But this ginormous creature or thing had been growing for at least 5 years in her abdomen. When asked later why she waited so long to come see us, the family said they had been saving up their money for a surgery.
On examination her belly was taut with a huge solid, irregular mass. You couldn’t see much on ultrasound. It was hard to distinguish what was what. It was clear there was no 5 year old baby though. On vaginal examination, her cervix felt normal, so it gave me some hope that we could get this mass out and that it might not be cancer.
Our working diagnosis was a really big ovary that had taken over her entire abdomen.
We told her that we would try to take it out. But if it was advanced cancer, we would have to open and close only. The family agreed. It was either that or nothing.
The week of valentine’s day our MCD was spreading rumors that we were killing people in the operating room (which is not true). We were trying to decide to take a break or not. We took one afternoon off from work. The nurses were threatening to go on strike for us. We were unsure what to do.
The following week the operation requests come in by the hoards. We spent the entire week with a list of 20 surgeries paid for and awaiting then turn. It seemed that every time we finished one operation, two more came in. This lady was one of them. She had been suffering so long (like so many people here) that we could not just leave her until after the problems with MCD resolved (which may be forever).
My dad and I made a small-ish incision below her umbilicus just to peek. Then we made it a little bigger.
Attached are a few bloody pictures (sorry). Please beware of the blood and guts and don’t scroll down if you don’t want to see.
“Wow! Those look like huge snakes!” We were actually looking at huge dilated veins of the omentum that were 2-3 cm dilated in diameter. The omentum was attached to this big mass. If you put your hand in past the veins, you would accidentally break one open and she would bleed like stink (bleed like stink=actually a medical term). So we had to carefully clamp and tie off each one.
After clamping off several huge omental veins to free up the mass some, I finally was able to get my hand into her abdomen. It was definitely ovary, and it didn’t seem like cancer (ie, wasn’t adhered to everything).
It was still difficult though because of all of the vessels that had been growing and thriving like leaches for years and years.
Once we freed the huge ovarian tumor from the omentum, it still had some vessels to the sidewall and posterior abdomen. It was EVERYWHERE, but was able to be dissected (unlike difficult advanced ovarian cancer).
Finally we detached the HUGE ovary from everything except the uterus (which it seemed to be adhered to). I had Ross scrub in just to help us hold the thing up so I could see beneath it.
Did I mention that it was BIG?
It was so difficult to hold up, that I cut the largest portion free from it’s base that was stuck to the uterus before finishing up with a hysterectomy (a much simpler surgery at that point).
We put everything into a large basin. How much did it weigh? 16 kg without the weight of the basin! That’s a little more than 35 pounds!
How would you like to lose 35 pounds in 1 day?
We finished up by irrigating and tying off a few more additional bleeders coming from her omentum, upper abdomen, and sidewall.
She received several transfusions during the surgery, but she was fine.
Usually if something interesting happens in the OR, everyone hears about it outside. People were coming and gawking from everywhere, with their eyes popping out as they looked at the specimen.
I heard that the sous-prefet (a local authority) came to see, as well as other important people. Someone even called the radio, who came to interview her, and then broadcasted her story on the radio.
You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. We believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. By donating through AHI, you can be reassured that there is a strong measure of accountability following your donation. Just mark the donation for ‘Bere.’ And remember that your gift is 100% tax-deductible.
Olen Zain: +235 62 16 04 93
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
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