199. Svay Rieng Day Six

First patient today a 29 year old with an easily palpable mobile, non-tender cyst.  Mobile means not held in place by scar tissue which is more likely to develop with cancer or infection or endometrioma.  An ultrasound showed a 10 by 13cm solid mass.  I'm surprised that it is not painful.  Surgery showed a solid left ovarian tumor, not dermoid, probably not cancer.

This is the last surgical day, generally no complicated cases because we leave tomorrow which doesn't leave much time for follow-up, but yesterday I saw several more women needing surgery and I did not want to turn them away, so I kept adding on more patients.

Thien Mok, 45 years old, requested a hysterectomy because she had been told she has cancer; sounded like...

Finally, a 6* year old relative of local doctor with a mass on the upper right abdomen.  It was easily palpable, mobile, non-tender and by her history present for only a few months (which I doubted).  It seemed too far up for an ovarian cyst, but I couldn't come up with a plausible alternative so I agreed to operate under the assumption that this was a benign ovarian cyst.

It was not ovarian, and was easily dissected away from a base of fibrous tissue--no clear attachment to adjacent organs.  The cyst's contents were a solid but soft white tissue, that I would best describe as cooked cauliflower. The procedure appeared to go well, but the next morning her abdomen was distended.  

Internal bleeding can cause distension, but her vital signs were stable.  Accumulation of bowel gas is common after abdominal surgery but this seemed like a lot overnight.

Unfortunately the team was leaving and I had to leave her with local surgeons.  This is a hospital that performs cesarean deliveries, appendectomies, and treats abdominal surgery, so I was not uncomfortable leaving, but for future missions, I will not operate without a general surgeon on the team, and I will not do major surgery on the day before I leave.