November 28, 2007

• Bungholes of the people and tree variety

  Today I gave a rectal exam-through the abdominal wall.

  Now i know what you are thinking-Josh, people dont have rectums in their belly buttons. And ordinarily, you would be correct. But in the magical world of surgery, sometimes people need things called colostomys. And there begins our story.

  So a middle aged gentleman came in with what one might call a gluteal abcess on the right buttock. Ordinarily this would be a simple incision and drainage procedure, more for medicine than surgery. Only problem is, whenever said gentleman had a bowel movement, some of his fecal matter would invariably end up in the wound, contaminating it. Well this is no way for anyone to get better, so he was schedule for something called a diverting colostomy.

  This procedure involves making a small incision in the stomach, picking up a small loop of bowel to the incision, and then cutting it open. Not severing the bowel tube, merely opening it enough that there is almost a u-shaped type tube coming out the incision. One end goes from the esophagus to the new hole in the belly, and the second goes from that same hole down to your anus. The two ends no longer communicate, and this hole, also called a colonostomy (since it comes from the colon) or stoma for short becomes your new anus.
  
  A seal is placed around the stoma to prevent leakage, and then a bag placed over the seal, so anytime you poop, waste material goes into the bag and never reaches your butt. It is kinda like having your own personal pooper scooper. So in order to make sure one is IN the colon once the two halves of tube have been opened, it is necessary to insert a surgical instrument, or medical student finger into the opening to look for fecal matter.

  It was found.

  And no, this does not have to be a permanent operation. In this fellows case, as soon as his abscess is healed, the two halves can be joined together again and his bowels will resume their normal activity. For others though, this could end up being lifelong which I am sure is quite challenging as the novelty of pooping through your stomach probably wears off after a couple day. It is however, a fascinating surgery to watch, and convincing me more and more that whatever aspect of medicine i go into, surgical or otherwise, I should strongly consider subspecializing in GI because I am twisted enough that I like it.

  In other non-medical news
  Teacher may be whipped with forty lashes for allowing her class to name a teddy bear 'Muhammad'.
  
  I guess the Sudanese government found this perceived insult to their religion to be...un-bear-able?

  And back to medical news.
  

  
  This tree man has HPV. So let that be a lesson kids. wear a condom. And beware tree hugging hippies. Every time you touch one, you are touching EVERY tree they have ever been with
  
  

  • 8:17 pm
  • 3 Comments