Pediatric surgery is seriously awesome. I wish I had had more exposure to it in the states, but super grateful I get to experience it now! The hospital staff is really great here and super friendly in the OTs (operating theaters). The attendings (counselors) and residents (registrars) are awesome and they love to teach!
Monday I was able to see another anoplasty, but this was a “redo” of a previous anoplasty that did not take. This was similar to the last anoplasty I had described.
Then I was also able to watch a choledochal cystectomy plus choledochojejunostomy. Sooo… Choledochal = chole (relating to bile) + dochal (duct) = bile duct! cyst removal
Choledochojejunostomy = bile duct + jejunum (part of intestine) + ostomy (creation of an opening) = attaching the bile duct to part of the intestine!
So basically we had to remove the cyst and then once it was out you needed to attach the bile duct back to something! Well unfortunately in this little baby’s case the bile duct was paper thin, so it took an extremely long, tedious amount of time to dissect a part to attach to the intestine. And as you can see in the photo, they have to cut the jejunum and attach it to itself. Then they attach the bile duct (or whatever remnant is left) to the jejunum as well! And also as you can see the pancreas/pancreatic duct Are still attached and therefore everything meets in the jejunum (bile + pancreatic enzymes + digested material). Prettyyyyy crazyyyyyy. And amazing! And this procedure only took about 7 hours! (Sarcasm.)
Then I got to see another Mitral Valve replacement which was really cool because it was a 5 year old little girl who had ALCAPA (anomalous left coronary artery from the pulmonary artery) which I have only ever heard of from studying for boards but never thought I would see!
In the photo – note the BLUE left coronary artery in the photo on the right. That means that blood is NOT oxygenated. And so this child had a heart attack at 4 years old. This condition caused her one heart valve to become very stenotic (stiff and barely moving) and that is why she needed a valve replacement! I am unsure what the rest of the plan is for this little girl because I am fairly certain she will need more surgeries to correct this. Amazing to see the extremely small valve outlet in the heart and then the opening with a new valve!!
Later in the day, I went to a radiology conference where I saw two diaphragmatic hernias (there is a defect in the diaphragm that allows the intestines protrude up into the area where the heart and lungs are!) . I saw tuberculosis spread to the kidneys – which they said is the only case of that they have seen here (and they get a ton of TB). I also saw two X-rays of very dilated loops of bowel..so we were able to go through the case – the patients history (in both cases these were newborn babies) and their physical exams and their imaging to come up with a differential and decide what was the most likely diagnosis. One case was ileal atresia (the ileum is part of the small intestine and basically the intestine just stopped there!) and one case of an imperforate anus (no opening where the anus is). I actually loved this radiology session! I learned a lot in that one hour and got to see some very interesting cases!!
I went to the botanical garden one day after work to read and explore. It was really wonderful! I stayed until the sun set below the mountain – which was like only 6 PM.
On Wednesday I saw a gigantic “pseudocyst” taken out of the abdomen of an 11 year old. Pseudocyst basically means a fluid-filled sac that looks like a cyst but maybe isn’t. This definitely was NOT a cyst. This was a very large mass. When you looked at the child’s belly, you could see the mass protruding out. In the states, this would warrant a biopsy, but here they use less testing/imaging. Due to its size, they just decide to take it out. We are waiting on pathology results to see what it actually is. The surgery took about four hours because the mass was adherent to the back of the abdominal wall and to the kidney. It ended up weighing 3 kg (approx 6-7 lbs). It was unreal.
I went to a free concert on Wednesday night with two of my program directors! It was so much fun! The music was awesome and everyone was just having such an amazing time! The Annual International Jazz Fest is this weekend and it is a huge event! So this is a small preview of what the concert will be like. It was a really fun night and we went out on Long Street afterwards which was cool to see what the nightlife is like!
Friday was a wild goose chase to fill out my residency contract. It was nuts. I felt like I went to one million places to get everything that I needed together. It’s tough without a car. You’re definitely not meant to do this in another country lol. But I finished it! And met a med student from Austria that day so we chilled at the waterfront to get some food and then went into the city! It was super cool to hear about their healthcare system and how their med school is in Austria. One of the coolest things she told me was that they are given sterile shoes to wear in the OR. You don’t wear your own shoes with booties like in the US!
A waffle from the waterfront!
The new American students come this weekend! Im pretty excited to have more friends here to hangout with! 🙂 No more selfies with ghost friends! Im still just so incredibly grateful to be here!