Elective Colorectal Surgery at Mulago

Participated in two exploratory laparotomies today with Dr. Masiira, the Colon and Rectal surgeon here at Mulago Hospital. The first patient was a man in his 70's with a palpable abdominal mass but no obstructive symptoms. Not being able to afford a CT scan preoperatively, there was no way to assess resectability until the patient had already been subjected to a large midline incision. Once this was done, we found the tumour to be a solid lesion approximately 18cm in diameter arising from the serosal side of the mid-sigmoid colon and replacing the mesentery. It was firmly adherent posteriorly, involving the left ilac vessels and extending up to the aortic bifurcation. The blood loss from just exposing the tumour was almost 1L. Thus, the decision was made not to resect.

The second patient was only in his mid-thirties. He had been having obstructive symptoms and frequent bloody stools. He also had a large palpable mass. Again, no money for a preoperative CT and no colonoscope in the hospital so no way to assess tumour preoperatively. The patient had a very difficult airway and there was no working suction (no money for disposable tubing) so a few tense moments for UCSF Anesthesiologist Matt Aldrich during induction. We found a 6 cm mass in the transverse colon extending into greater curvature of the stomach. No obvious liver lesions palpable. We performed an en-bloc transverse colectomy and partial gastric resection. Blood loss was still significant. No functioning electrocautery so the knife and scissors are used with lots of packing afterwards. Not enough suture available to clamp and tie small vessels. It's saved for the larger vessels that need to be ligated.

Air conditioning not working today and roof leaking from heavy rain so particularly heavy odor in the air. That on top of jet lag made for a few pre-syncopal moments in the middle of the cases. I haven't had that happen since I was a first year medical student!