Friday, April 18, 2008

Mission....... Possible

Lovely case last week. 99 year old lady (yeah, that's right) came in with abdominal distention, pain and dehydration. She was a pretty sharp old broad, though. Knew what was going on and lived independently. CT scan showed evidence of a large bowel obstruction, transition point somewhere in the rectosigmoid area. Flexible sigmoidoscopy was unable to maneuver the scope past the narrowed area, but it didn't look like a mass. I saw her and she had focal peritoneal signs and feculent matter coming out her NG. Her daughter was there and we went through the options. Option one: Do nothing, make her comfortable, with the understanding that she probably wouldn't survive much longer. Option two: Big operation, bowel resection, likely colostomy, with significant risk of perioperative complications.

They went for option #2. My mission, which I accepted, was to try and get this lady to her centennial birthday. She turns 100 in the middle of May. Lot of pressure, no?

Basically, she had a diverticular stricture with a mass of small bowel matted to the inflammatory process. Tough operation but she tolerated it rather well, even extubated at the end. Today she goes to a rehab facility. I still have to get her through the next 4 weeks, but I'm starting to like our chances.

Operating on the extreme elderly is starting to become commonplace as our society ages. I'm sure in ten years residents will be competing to fill fellowship slots in the highly lucrative sub-specialty of "Geriatric Surgery" but that's a topic for another day......

5 comments:

rlbates said...

Sure hope you get to see her blow out the candles on her birthday cake. Wow, what a party that will be!

platensimycin said...

Simply admirable, both for the healthcare provider and the patient alike. May is just around the corner; please keep us posted!

Jeffrey said...

wow. Geriatric Surgery. looks like you're a pioneer now wouldn't it? ;) however, i have a question: would the challenge lie more on the anaesthesiology side of things rather than the surgery side?

make mine trauma said...

Hooray for option two! She's a May baby and no doubt tough as a bull. I'm betting she celebrates 100 years and invites you to the party.

clayton77 said...

I WAS IMPRESSED WITH YOUR ACHIEVEMENTS. GOD BLESS YOU FOR YOUR COURAGE AND ENDURANCE.

I AM 80 YEARS OLD WITH A LARGE INGUINAL HERNIA, BUT SURGEONS ARE AFRAID TO OPERATE ON ME BECAUSE THEY CLAIM THAT THE ANESTHESIA COULD KILL ME OR LEFT ME WITH DEMENTIA. IS IT TRUE?

CLAYTON