Just two patients again today. I had been sharing an operating room with a general surgeon doing mainly hernias, but he left yesterday after just three days of surgery. A lot of travel for just a few days, but he said that running a metropolitan trauma service left him burned out, and he thought that overseas work would be a win-win. There were also hints that a bitter divorce influenced his decision.
A vaginal hysterectomy for prolapse in a 48 year old, and bilateral removal of ovarian endometriomas in a 24 year old. In endometriosis, fragmented clusters of cells from the uterine lining migrate outside the uterus, ending up on surfaces anywhere in the abdominal cavity. On the ovary, these clusters can form cysts called endometriomas, or "chocolate cysts" because of the thick brown fluid contents of the cysts (encapsulated blood turns brown).
Endometriosis can cause painful periods and/or infertility and is difficult to treat, especially in Cambodia.
Wednesday, August 19, 2015
Sunday, August 9, 2015
197. Svay Rieng Day Four
Today's OR schedule could have come straight from any of my home surgery days. Two enlarged uteri--fibroids--too large for a vaginal approach, so both were abdominal hysterectomies.
Both women had never given birth, perhaps infertility caused by the fibroids. Or perhaps reflecting the loss of a generation of men during the Cambodian genocide.
[Next week I will be operating on a woman who finally conceived after several years of trying and an operation that removed several fibroids but left the uterus intact (called a myomectomy, the medical term for fibroids being myomas). She has again been trying to conceive for a few years but new fibroids have appeared, so another myomectomy and crossed fingers.]
Fertility was not at issue for the 54 year old and the 43 year old declined the option of a myomectomy.
Both women experienced minor complications--the first a small tear in the bladder, easily repaired, and the second post-op fever, treated with antibiotics that I brought with me.
A reminder that any hysterectomy anywhere has about a 5% risk of complications.
Both women had never given birth, perhaps infertility caused by the fibroids. Or perhaps reflecting the loss of a generation of men during the Cambodian genocide.
[Next week I will be operating on a woman who finally conceived after several years of trying and an operation that removed several fibroids but left the uterus intact (called a myomectomy, the medical term for fibroids being myomas). She has again been trying to conceive for a few years but new fibroids have appeared, so another myomectomy and crossed fingers.]
Fertility was not at issue for the 54 year old and the 43 year old declined the option of a myomectomy.
Both women experienced minor complications--the first a small tear in the bladder, easily repaired, and the second post-op fever, treated with antibiotics that I brought with me.
A reminder that any hysterectomy anywhere has about a 5% risk of complications.
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