Sunday, May 4, 2008

Baby Brian

I am on call this weekend. Compared to some weekends on call, this one has been relatively quiet. No CSections thus far, but I have had some phone calls and ER visits. I sewed up a lady's finger that had a large laceration, almost the whole length of her finger. She had a fx also, but I had to remove some of the bone to put it all together. I am not sure how much function she will have in it, we shall see. I also got to debride a child's burns on his arm - something I have not done before. She fell into a fire and had burns up her arm to her elbow. Thankfully, they weren't too infected so I am praying she does well. One of the last patients I saw today was a little kid, Immanuel, who was found head down in water, a near drowning victim. He was breathing on his own, moving all extremities, and responding to voice and pain, so I pray he does okay too.
Baby Brian was the most interesting case of the day. I was called that a child 3 days old was born at home in the village, and was vomiting and had abdominal distension. I assumed it was probably just sepsis in a newborn, so I gave some orders and headed down to check him out. When I got there the family reported that he hadn't been passing stool since he was born, but was urinating okay. I pulled back the blanket and found a very distended abdomen, very tight, with no bowel sounds. I saw him vomiting through his mouth and nose. He looked very sick.
When I saw him and his distension, he reminded me of a kid I had seen in Ghana when I was there as a medical student. This kid, on the R, had Hirschsprung's disease. Hirschsprungs is where the nerves going to the anus don't quite make it. So the muscles which help to pass stool don't work, and they get backed up as a result. It is kind of like they have no anus, because very little if anything comes out. We performed surgery on the kid in Ghana to relieve his obstruction and gave him a colostomy, which was suppose to be corrected months later.
On Brian, I finished checking the front of him and proceeded to the backside, where I discovered he didn't have an anal opening. He had some stool on the nappy, but just traces, so I thought maybe there was a small opening. I saw Jim was heading down to our English Lotu Potluck, so I went outside to discuss the case with him. Initially, he thought we might be able to cut a piece of skin that was obstructing the opening and dilate it, and do surgery later. However, after discovering that the stool was really coming from a fistula on the scrotum, and no other opening was found, he determined he would need to do surgery. One of the most challenging things was trying to put an IV in this little kid. 3 docs, 2 guys from OT, 1 nurse, and lots of prayers and we finally got it. Continue to pray for Brian in these next few days and for the Lord to give Dr. Jim wisdom in deciding who should do the surgery (him vs asking pediatric surgeon in Hagen to help), and to guide the hands of the one who performs it.