First, a vaginal hysterectomy today for a 33-yr old nun (self-pay and able to afford a room on the "private" ward--two beds to a room in contrast with the open wards elsewhere, and a higher nurse to pt ratio).
Then, a myomectomy (removing 12 marble-size fibroid tumors, leaving the uterus in place). She is 34, never been pregnant but wants to be. She lives in South Africa but couldn't afford this procedure there, so she came home to Malawi for the procedure.
Finally, the excision of an ovarian dermoid cyst. A dermoid cyst follows an ovary's attempt to clone itself. It gets as far as some hair, cartilage, sebacious goo, sometimes a tooth or nerve tissue but nothing organized or complicated. This young woman presented with an abdomen distended with ascitic fluid, usually associated with liver disease or cancer.
When an ultrasound showed on ovarian cyst, we were concerned about cancer, but after surgical drainage of 12 liters of ascites we removed a benign ovarian cyst. There was no consistent lab evidence of liver disease, and I later found no reports of dermoids associated with ascites, so this remained a puzzle.
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