As a surgeon, what is the most shocking thing you ever saw after opening somebody up?
The most shocking thing I can recall seeing after opening a human abdomen was… drum roll please…. Another human being.
I was operating on a teenage female who came into the trauma bay after a relatively minor car accident. She was complaining of worsening stomach pain and then became acutely unresponsive. Her blood pressure plummeted. I ran through in my mind the usual suspects— busted spleen, air leaking out of the lungs, bruised heart, fractured and bleeding pelvis. I started transfusing and put an ultrasound on her belly.
When I say ultrasound, in the context of trauma, we are looking for “free fluid” in the abdomen, presumed to be blood from something bleeding. Of course, even with the rapid “FAST” scan I do (not being an obstetrician) I still saw the fetus. Ok, fine, I can work around that. I did remember noting that for a fetus of its apparent age, it had relatively little amniotic fluid surrounding, a condition called oligohydramnios. Which was worrisome, but not my first concern. The goal in maternal-fetal trauma is save mom to save the baby. Mom had internal bleeding and needed a trip to the OR.
I’m pretty swift with ex-laps by now, and with a fresh scalpel I can teleport from skin to abdominal wall in a single swipe. A second swipe puts me in the abdominal cavity proper. I was cognizant of the gravid uterus lying just beneath my blade and proceeded quickly as the situation demanded but also cautiously. Good thing too, because the moment I opened her up I was rewarded with a tiny fist bump. Sooooooooo surreal. Her uterus had ruptured from the impact, and she delivered her tiny but viable baby backward out through the uterine rupture, where he now rested, swaddled in a bassinet of small intestines. I call my OB colleagues and together we stopped the bleeding. Mom and baby did fine.
A surgeon’s life is full of surprises. You go in expecting a leg spinner,and often wince at a googly;
- Once we opened up a patient, who had suffered a penetrating abdominal trauma. I was surprised to find two letters in caps,inscribed on the liver. After extensive post-op research, we learnt that the patient had undergone a previous surgery, and the egotistical surgeon had inscribed the initials of his name on the liver, just before closing.
- A 19 yr old girl was brought to casualty with severe abdominal pain. Investigations showed a foreign body in the bladder, and we proceeded to open surgery. Imagine our surprise, when we found a 2 feet long wire inside the bladder. Briefly, the girl had a weird practice of using different objects for masturbation while under alcohol, and for once the object had made its way up the wrong passage. Btw, we regularly encounter a bewildering array of foreign bodies in the female bladder,and often the modus operandi, is much the same.
- A lady had an unplanned pregnancy. After her first child, an Intra-uterine Device had been placed by a gynaecologist in the immediate post-partum, just to prevent such an ‘accident’. Presenting with stomach pain to us,she underwent a battery of tests. Finally, we extracted an IUCD ( a type of contraceptive), from her bladder. I regard gynaecologists very highly,and this is meant as no slur to these fine doctor colleagues, but for the world of me,I couldn’t imagine how a senior gynaec could mistake one orifice from the other, while placing an IUCD. When confronted post surgery, the gynaec stuck to her guns, and threatened to sue us for ‘motivated lies’.
- Once we had the unenviable task of removing a steel glass, with an inscription ‘ A gift from my sweet Priya’, from a teenaged boy’s rectum. We never doubted that Priya should have indeed been a very sweet girl, but we still felt the well intentioned gift could have been put to better use, at the other end of the gut.
- The lay public may not be aware how often a mother brings a 14,15 yr old daughter, saying-” Doctor Saare, my daughter has a ‘katti’ ( lump ) in the stomach.” Many times we have had to convey the good news, that the 14 yr old girl had a ‘Kutti’(Baby) not a ‘Katti’.
It goes without saying that a veterinarian can find all sorts of surprises in surgery, because dogs, and even cats, aren’t necessarily discriminatory about what they eat or what can get lodged inside of them.
I know this question is about opening “somebody” up, but many Quorans consider their pet a “somebody”, so here it goes!
I can speak from experience from my own cat. He was never a puker, as some cats are, but around mid-February he started vomiting violently at no discernible time — before eating, after eating, in the middle of the night. A radiograph of his abdomen showed something lightly opaque in his stomach. Luckily I was able to slide an endoscope down for a peek before cutting him open, and upon popping into the stomach I was frightfully greeted by Santa Claus staring down from the enormous video display. This was the thin, pliable rubber Santa Claus head that was attached to a pipe cleaner body and affixed to a Christmas present two months earlier. He loved carrying that Santa around, and it just disappeared. I had assumed I would find him under the refrigerator or the stove with all his other toys. Nope. It sat in his stomach until gastric acids hardened it, turned Santa into an African-American version of his original self, and started poking him in the stomach uncomfortably. I was able to retrieve it without surgery.
I have removed tampons, socks, underwear, class rings, diamond studs, loose change, tennis balls, and a host of other things from the stomachs of dogs.
But the craziest surgery was on a 10-month-old Lab mix who was the goofiest, sweetest, wiggliest beast you could ever hope to meet. Typical 100% puppy. His owner brought him in to see me to examine a firm swelling on his side. It wasn’t painful. The dog was not bothered by it. It wasn’t red or angry or seeping. It was just a lump. Examining it through a thousand dog kisses revealed no reason for it, and thinking it could possibly be an infected cyst of some kind, I sent the dog home on a week’s worth of antibiotics and instructions to return.
The dog came back with great joy and exuberance to see me again, but the lump was still there. Maybe it was a bit bigger, but besides being obviously present, it created no problem for Mr. Wiggles. Still, I advised an exploratory surgery of the lump to see what was at its core. With a young, energetic pup, it was always possible he had gotten a thorn or stick or other type of plant material wedged under his skin that was creating a localized reaction.
Almost immediately after incising over the questionable mass, I encountered wood fibers. Aha! I was right! The little bugger had run a stick under his skin. Odd though that no sore or lesion was found before this. As I continued to dissect around the exposed stick, more and more bark became evident. Christ! How did THIS get here?
Once I had the wood exposed, I grabbed it, expecting it to pop out of its encysted casing so that I could just clean up the surrounding area and close the surgical wound. I grabbed it. But it didn’t want to budge. I tugged a little harder. Nothing. I tried to undermine it, but I just couldn’t seem to find defined borders. I tugged again. This time there was some give… but all that happened was MORE wood was exposed.
Cautiously, I kept pulling. The best analogy is to think about the handkerchief magic trick where a never-ending string of colored handkerchiefs tied together just keeps coming and coming and coming out of a pocket or a hand. In this case, more and more wood kept advancing out of the dog. The little chunk of wood embedded under the skin turned out to be an approximately 8-inch branch.
Mr. Goofball had apparently swallowed this stick whole. At some point in time it decided to perforate the stomach and work its way out of the side of the dog. The dog never vomited. The dog never stopped eating. The dog never stopped playing. The dog never showed signs of discomfort. The dog frankly didn’t care that it was impaled from the inside out.
This, of course, turned into a full abdominal surgery to clean out the wound and surgically close the stomach, but the body had formed a nice protective channel around the stick as it perforated the stomach, and the dog had absolutely no evidence of peritonitis. He recovered uneventfully, awakening to give his doctor and all his nurses many, many kisses.
The owner later framed the branch we returned to them with a picture of their sweet little monster and his astounded veterinarian.