83. OP#9: Riobamba II

Day 5

Peak day: three major cases.

Two vaginal hysterectomies for complete uterine prolapse (the uterus literally descending beyond the vaginal introitus).  Marie, in her 80´s, has high blood pressure (non-compliant with recommeznded meds) but otherwise a good surgical candidate.  A combination of age, life-long straining (heavy lifting, multiple and difficult deliveries), malnutrition, and perhaps genetic factors combine to cause the prolapse. Marie Dina (on the left with her husband and my ever faithful translator Sarah) is only 51 but with 8 vaginal deliveries...

In her early menopause, Judith received "injeciones," presumably estrogen, not uncommon anywhere in the world at that time.  She does not remember taking progesterone which protects the uterus from uterine cancer, a standard approach in the past 30+ years.  At sixty she experienced an episode of bleeding but was told not to worry about it. Now 62 she presented with persistent bleeding and in our clinic a markedly abnormal ultrasound. Surgical findings showed multiple fibroids (the white mass at top and the egg-shaped mass that was removed early in the case to make it easier o access critical ligaments) and malignant tissue extruding through the uterine wall, making her a candidate for chemotherapy without need for staging.  I did not do a omentectomy (removal of a layer of intraabdominal adipose tissue) which is usually performed since the omentum frequently is an early locus of metastasis.  But her omentum was normal by palpation and wanting to keep the operation as simple as possible, I left the omentum in place.  A difficult decision.

My translator Sarah noted her carrying a set of car keys with an electronic opener, so it is reasonable to assume that she can afford chemotherapy.... (more to follow)