I was in the delivery room the other night with a lady who wasn't making progress in her labor and so I asked our nurses to get her ready for a C-section. As they were doing that, they asked me to see another woman in labor. I checked on her and found her to be ready to push, and told them I would check back after I did the first C-section.
I did the first C-section with a PNG Rural Registrar, Cindy, and we delivered a healthy baby girl and then I went back to D ward to see how the 2nd patient was doing. I found her pretty much unchanged, and decided she too needed a C-section. Unlike the first patient and all the other C-sections I have done, this woman was different in that she had a colostomy from having an imperforate anus as a baby. That means, she was born without a way to excrete her waste and so as a newborn, she had surgery to allow her to excrete her waste through a connection of her bowel and her abdominal wall. Anytime someone has had surgery before, there is the concern for scar tissue which can make the anatomy a bit tricky to distinguish, and so I went into this C-section with a more heightened awareness and alertness.
As soon as I started to make my incision and go in, I found lots of scar tissue and wondered if I was in over my head. It was after midnight at this point, and I didn't want to bring Sheryl, the surgeon, in if I didn't have to, but after struggling for about 15 minutes - I finally said to call Sheryl. Sheryl got there and made quick work of getting us in, but once we got in, we found some other challenges that awaited. Her uterus was adhered to the R side of her abdomen, and her bladder to the lower end of the uterus. It was more than difficult to get the baby out, but thankfully after a lot of effort on Sheryl and I's part we managed to get the baby out, and thankfully he breathed quickly thereafter, he was going to be okay.
We now focused on sewing mom up and as we struggled with bleeders and exposure because of the adhesions, we didn't feel like this mom should be undergoing any more operations, or else she would be risking her life. We talked to her about this and she agreed to have a tubal ligation, and so we started on that process after suturing the uterus closed. Cindy made quick work of the Right fallopian tube, but when we went to find the Left one, we didn't see one. Sheryl looked around and pulled out something, which initially we thought was a large ovarian cyst or mass, and instead determined was a 2nd uterus which had the Left Fallopian tube and ovary attached to it. We think the uterus's were connected below the cervix and so we didn't enter in the 2nd one with our section. Cindy tied off that tube and then as we were irrigating and making sure everything was okay, we located the appendix and found 2 of them. We took both of them out too, as if she had appendicitis, no doctor would believe that she could get it again, we all only have 1, but in her that wouldn't be true.
So what started out as just a C-section turned into an operation on a woman with 2 uterus with separate ovaries and fallopian tubes and 2 appendices. It was quite interesting for all of us involved and we all agreed that the next patient we see with a history of an imperforate anus, is going to have a surgeon schedule their C-section from the get go, instead of being surprised at midnight with these findings.
