Black abdomen

Monday, 3rd September, 2018, time check, 6:10pm. Phone rings. Who is it that could be calling at this minute where the very meal I had craved for the whole day was right before me, ready to be the object of my devouring gut. I had not prepared such appetizing noodles in a long while – maybe attractive to my sense. Especially not after a month long leave where good homemade food had been the treat of my buds. And the phone’s screen read, “Dr. Affram, VRH – Surgeon”, my boss and head of department. Speaking to the hungry man in me, “what could this call be about?”. Especially when I had spoken to him earlier in the day to know directly from him that his nearest geographical location was at least two and half hours from mine – Accra and Ho. The hungry and salivating man in me had put on the id and detested to the core the urge to answer the call but my ego requested of me to do what was GODLY. The words from his end of the call were not the most palatable, “My friend, your leave is over. I need you in the operating theatre now”. My super-ego then whispered to me. “Man shall not live by indomie alone”, though indomie was necessary at the time, I had to take two bites, cover the rest and make straight for the theatre.

All along my walk to the hospital, the thought on my mind was “so what sort of emergency it could be that had dismayed my super to such an extent?”. Arriving at the theatre, I realized there was not but two cases. The first case being that of an ischiorectal abscess with proximal extension to the upper thigh who had earlier in the day presented in a state of septic shock. The case entered theatre and though not pleasing a look to the eye, in a matter of one hour, was well dealt with.

Then came the case for which I was called to assist. A hernia. Strangulated as it was. Hearing of hernia, I was happy. This wasn’t going to be a long surgery. Even if there was the need to extend the surgery, it wouldn’t be too much. I can still manage to return to my indomie in a somehow warm state. That sumptuous bit of treasure had to go down my gut.

Client positioned supine, general anesthesia instituted, surgeons and scrub nurse scrubbed in and well gowned. Time check, 9:00pm. Surgery good to begin. As usual, with all aseptic techniques followed, client draped as well, scalpel was good to make its first incision in the groin over the hernia into the hernia sac. Exploration of the hernia sac will determine the duration of the surgery. At this juncture my greatest wish was that there shouldn’t be any loop of gangrenous bowel. Gods answer to my prayer was a bit swayed to the negative.

“I suspected this, a carpenter’s hernia. When I learnt he was a carpenter, I knew what to anticipate” Dr. Affram complained. Then I knew we were in for a long day. In there in the sac was a loop of oedematous, gangrenous and inter-locked small bowel. Attempts at reducing proved impossible and the possibility of causing a perforation on forceful attempt was a hindrance to any further advances. A midline incision meant the need for a laparotomy to be done then.

The characteristic smell of gangrenous bowel had already taken over the flow of the atmosphere in operating theatre. So the midline incision was made, entering into the peritoneum, what the two balls in the sockets of my skull saw threw the mouth of my emotions wide open within me.

For a moment, all I could see was a black abdomen – more like a cobra packed in this man’s abdomen. “This man is finished” my boss explained. A gradual precise, calm, attentive and diligent attempt to reduce the locked up bowels yielded good – now was the time to inspect the length of bowel that had lost its integrity to the impact of that neck which had squeeze all the blood out of it, rendering it into spoils. Indeed, I had known hernia could become irreducible, and with irreducibility, maybe strangulation which may render a bowel dead, but this length of 150cm of gangrenous bowel spanning from beyond the ileocecal junction with a greater portion of the ileum might be the longest I would have or will ever come across in a lifetime of practice of medicine. This meant right hemi-colectomy with an illeo-colic anastomosis, was the only way out. As we went about it, the thought of this man living with a short bowel syndrome kept running through the tired mind of mine.

Three and half hours into the surgery and I could feel my bladder needed emptying but that part of me that acts on perfectionism principles would not allow that just yet. Hardly did I know the feeling was mutual. My boss was also feeling same. Though we tried to keep it till the end of the surgery, the urge was later unbearable. Away with the arteries and retractors we did, on the ground the gloves and scrubs found themselves and into the embrace of the bowl we run with the content of our bladders.

Having been released of the possibility of running into urine retention, we calmly re-scrubbed in to continue the surgery. The anastomosis was completed, hernia was repaired via Nylon Darn and midline incision closed.

Tired as we had been, surely, two lives on the verge of transition had been saved by God using us as His hands.

Just before we would enter my boss’ Audi to drive home, he said, “you must write something on this too. That you and your boss almost run into urine retention during a four-hour surgery and had to run to the tubs in the middle of the surgery to ease yourselves”. Surely, that I have done.

I got home, with the indomie still in mind, microwaved it and had gave it a rightful end.

To add a bit of advice, if you know anyone with a hernia, though it is not a life threatening condition and may not cause any problems throughout a life span, the possibility of complications remain and may at times be untoward. Help educate people with hernias to seek surgical attention.
To God be the Glory

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