Cases in surgical posting

I was too addicted to the korean drama series and taiwanese programme for the past 3weeks and totally neglected my blog. Despite being in the paediatric department this month, I was busy with the research data entry and doing my own private study. Now i would like to present the cases i have seen in my previous posting- the surgical department. To be honest, surgery is not my cup of tea, i have chosen it to be my second posting just because i think i need to go but not that i am interested to go. We have early surgical ward round, normally it ends within an hour, it was boring and less busy as compared to the medical ward. The more exciting part for this posting would be going to the operation theatre.
For the first time i knew i could go to the OT, i was excited. I have been looking forward to see surgical cases, eg: cardiac bypass, thyroidectomy, nephrectomy, colectomy, gasterctomy, appendectomy, cholecystectomy, hysterectomy... however, i knew the surgeon i was attached to was a general surgeon, i woulndt get to see neuro-, cardiac and orthopaedic surgeries. He's Mr JB and he would only deal with surgeries that involve the lower GIT as he other colleagues would cover the other surgeries as they seperate their cases according to the parts in abdominal caivty that they deal with. So basically i have seen loads of lower GIT and pelvic surgeries last month.
The main diffenrence between attachment of medicine and surgery would be you dont normally know what the patients come in for, coz their surgical date was pre-arranged weeks or months ago in the surgical clinic. So the history for the following cases that i am going to present may not be very complete or accurate.
1) A 80y/o men, came in to the theatre for chronic abdominal pain. Abdominal X ray was taken and the colon was noticed to be dilated. Other investigations have done to find out the cause of his colonic dilatation but none was contributory. The surgeon wasn't very keen in doing surgery on him as he was old and might not have good prognosis after that. However, the patient himself insisted to get rid of the pain by removing his colon. So on the 1st may 2008, which was the first day of my surgical posting, i witnessed a total colectomy that took two and a half hour. The normal diameter for colon is approx 5cm and his has gone beyond that, approx 8cm and was really super dilated. The surgeon has made the diagnosis of pseudo-obstruction after looking into his abdominal cavity and removing his dilated colon. he took the picture of it as he said he doesnt normally see this size of colon as according to his experience, he's only seen 2-3 cases per year. there was no organic cause that can explain his dilatation and this gentleman was sent to the ICU after that. However, his pain did subside but he was on a slow recovery. He was admitted to the ward for the whole one month and when i have left to the paeds department on 1st june 2008, he wasnt discharged yet. Coz in between his admission, he developed pnemonia and couldnt eat well after the surgery. I sincerely hope he's getting better although i do not know what happen to him after that.
2) Middle-aged men, who came in for right hemicolectomy as there were two large polpys in his caecum on colonoscopy. After removal of his caecum and rt colon, an ileostomy was formed in his right iliac fossa. A hole was cut across the skin and abdominal muscles, to let the terminal ielum to pass through. The terminal ileum was brought out to the external surface to prevent the enzymes from digesting the skin and an ileostomy bag was stuck onto the skin to collect the faeces. The rt colon that was removed was cut open, and the two polpys were seen, and their size were >2cm. the surgeon thuoght that they were adenomatous polpys and cancerous. it was a right choice to remove it before it was spread to the lymph nodes.
3) 40+y/o M, who came in for a sigmoidectomy as a mass was found in his sigmoid. it was supposed to be a simple surgery but unfortunately the surgeon found an adhesion between the spleen and the colon. He wasnt sure that was the mass extending from the colon or it was just an adhesion as a result of scarring. the spleen was known to be the a very fragile organ in our body and it could rupture very easily. while the surgeon was looking at the spleen to look for any scarring or infarct, somehow... i didnt know how it happen... the spleen was torn, as i didnt dare to question the surgeon. it was happened within a second... blood flew out from the torn spleen and suction was required. the surgeon had no choice but to remove the spleen. on removal of the spleen, an infract was noticed on the parenchyma of the spleen, that might lead to healing, scarring and further adhesion of the scar to the colon. then, the surgeon worked out on his sigmoidectomy. after removal of the sigmoid, a colostomy was formed on his left iliac fossa. as opposed to the ileostomy, colostomy was flat. a hole was cut and the colon was stitched onto the circumference of the hole. similar to the ileostomy, a bag was tuck onto the skin to collect the faeces. before stitching back the midline scar of his abdomen, the surgeon tried to cut a small piece of the normal spleen to implant it onto the omentum. hopefully, the implanted spleen can still carry on with his normal functional reticuloendothelial system. anyways, this patient has to take life long antibiotic as a reslut of splenectomy and anticoagulant to prevent thrombus formartion after the surgery. poor thing....
these are the major cases i have seen and i think it's worthwile to share with my fellow colleagues. the other surgeries are incisional hernia repair, partial spincterectomty/ anal fistula treatment, biopsy of anal intraepithelial neoplasia, laparascopy, laparotomy, stoma repair... i was once very kei poh, went down to the theatre even Mr JB was not around, the nurse was kind and brought me to the other theatre to see mastectomy and axillary lymph nodes excision. that was a bonus to my surgical posting. email me if you are interested in knowing more on other surgeries as this post is already quite long. hope u enjoy reading it.