Oh, how I long for a laparoscope!

Today was another first for me. An ‘old fashioned’ exploratory laparotomy. We had seen a fifty year old lady in clinic on Monday who had had close to six months’ worth of abdominal pain. Of course it was centred in the right iliac fossa and of course an abdominal ultrasound scan had suggested appendicitis (surgical readers will empathise with those last two sentences). Essentially what this means is that whilst I did not believe it myself, the implication was that she was having episodes of appendicitis. One slightly complicating factor in this clinical presentation was that she (of course) had had seven courses of antibiotics over that time period, greatly muddying the waters! After careful counselling her in clinic and with no CT scans available, I agreed to an operation. Whilst in the UK this would have been a laparoscopy (and this would be a not uncommon practice in such circumstances), here it meant a laparotomy (which is a much bigger deal). Whilst my heart was not really in it, it was the best option for her (I will resist wittering on and unpicking this statement any further). It was also a great learning experience for the team and so I made the most of it.

The team were indeed suitably delighted with the whole process. As was the patient to be fair. The procedure was (of course?!) normal. The appendix went in the bucket for good measure. A good result all round then?!

My mental scheming to consider how we might go about getting laparoscopic surgery here in the future gets another ‘marble of support in the jar’.

Next we went on to excise what can only be described as a small mountain from the buttock of a young man. It was a very impressive growth indeed. It turned out to be a complex lipoma. The end result was actually very pleasing technically and probably quite a big deal for him, I can imaging sitting on that was pretty unpleasant. And of course, skimpy beach ware is again an option for him!

For me, it was the closest so far I’ve got to operating on the rectum (non colorectal readers will miss the irony of this statement – my declared subspecialty sub interest is rectal cancer!).

Tropical backdrop to festive mince pies!

Returning home slightly jaded (one of the commonest expressions I am learning in Swahili is “nimechoka sana” – I am very tired) I received a healthy dose of pep-up potion. Kate and the girls had returned last night, and today had made mince pies! Such forethought in bringing a jar of mincemeat. Had I known this was going in at the time of packing I might have questioned the merits of taking it, I would now strongly advocate that it was worth every ounce of its baggage allowance!

There is now definitely a festive undertone in our household – whilst the temperature is confusing, we are certainly ‘warming’ to the idea of Christmas – Yo ho ho!