GOITERS

Every trip we have a lot of patients with goiters. This trip is no different. Many are large, bilateral, and substernal. We have done 25 total thyroidectomies in the last 12 days. 

Goiter

Large goiter with intrathoracic component

Large goiter that was cancerous

Opened specimen

MORE ODDITIES

This baby has a large cystic hygroma-a congenital multiloculated lesion of lymphatic tissue. It can be difficult to excise completely. We operated and the surgery went well.

Cystic hygroma

 This 7 year old has bladder exstrophy-a congenital condition where the bladder is outside the abdominal wall. He also has abnormalities of the penis. Surgery for this condition is highly specialized so I referred the patient to an expert in this area.

Bladder Exstrophy

RETROPERITONEAL SARCOMA

We have completed 50 cases in the past 6 days. Today we started surgery with a lady who had a giant abdominal mass. At surgery we found a retroperitoneal sarcoma. It was attached to the transverse colon, spleen and stomach. We resected the tumor along with a splenectomy, colectomy and wedge resection of the stomach.

Retroperitoneal Sarcoma

Next we operated on a man with a giant inguinal hernia. He had the hernia for several decades!

Giant groin hernia

UNUSUAL THINGS

We have been seeing some unusual surgical problems-even considering that most of what we see is unusual.

Dr. Bock taking a break

This lady has had this parotid tumor growing for many years. We will resect it this trip.  It will be hard to preserve the facial nerve.

This man has an ameloblastoma. It has been growing for at least 5 years. Today we will do a hemimandibulectomy.

This lady developed a cystic forehead mass after head trauma. She probably fractired her frontal sinus and has a traumatic meningocoele.

Frontal sinus trauma

This man has a 4 year history of a mass of the upper lip. Biopsy showed basal cell carcinoma but he

never came for treatment. The lip has been constantly bleeding so he has been applying a salve. He will need resection of the entire upper lip.

Basal cell carcinoma

This is an intraoperative photo of a lady with a large abdominal mass. It is hard to discern from the photo but there was a very large mass approximately 12 inches in diameter coming off the stomach. The mass had the consistence of a brain! It was hollowed out and connected to a large hole in the stomach yet the mucosa of the stomach was normal. There were liver metastases. I am not sure what the pathology will show.

Gastric mass

NO TIME TO RELAX

The first 3 days of surgery have been a blur. We have done twenty-six cases so far. Dr. Dabs, Ifeanyi, Gbaanador and Drs. Bock are here assisting with the work. 

Dr. Gbaanador

Today we had a special visitor-the woman I did a Whipple Procedure on this past May came for a followup. Hre jaundice has resolved and she is doing well. She will start chemotherapy. 

Patient with ampullary cancer s/p Whipple Procedure

Despite working hard, there are still 21 patients waiting for surgery. More arrive every day.

TRADITIONAL HEALER OR ALIEN SIGNS?

This lady showed up with massive splenomegally. She had been treated by the local native healer.

Traditional healer signs

Alien signs

ARRIVAL

I arrived at NCH after 46 hours of total travel. Twenty-one patients were waiting for me! Here they are-pointing to their problems. Dozens more are pouring into the hospital. Surgery starts today.