Uterine Cancer – Case Study

Transcript

This is about a 40 year old patient who was otherwise healthy and presented, or started having some symptoms of pelvic discomfort right around February, March 2020 timeframe. Right when the pandemic buzz was going around and right as the shutdown was starting. She was too afraid to go to the emergency room and did in fact call her practitioners. But at that time, just like everybody else, the primary care practitioners and rest of the other physicians didn’t really know how to deal with the pandemic. So essentially the answer was everybody had really shut down providing outpatient care at that time. So the patient’s symptoms progressed, she was not able to seek care. And again, did not want to go to the emergency room. And then several months passed, symptoms became so severe that she finally was able to get into a physician who immediately got her into care with me the very next day.

Now this is about 4 or 5:00 PM on a Thursday. And right after I saw her, I added onto my surgical schedule the very next day. Why? Because this was one of the worst abdominal exams I had performed on a patient. Her abdomen was rigid, hot, tender. I couldn’t even touch it. There was a big discoloration on her skin. And quite frankly, I knew that she had potentially something going on in her abdomen because an ultrasound had been performed by the physician prior to sending her to me, but just didn’t know what we were dealing with. As soon as I got to the operating room, as soon as I made the first cut, all of this odorful pus came out of that abdomen. What had happened is that she had an ovarian mass that ended up twisting, getting infected, had infected her whole abdomen. Since time had passed, the infection had seeped through her fascia, which is the strong abdominal layer that keeps all our abdominal contents in, gotten through to her muscles and the fatty tissue underneath our skin, and then infected her skin as well.

I had to call in trauma surgeons. I can’t remember the last time in my 12 years that I had to call a trauma surgeon to help me in an operating room. They had to remove part of her skin. We ended up removing much of her muscle, the fatty tissue underneath the fascia, and really just cleaning out her abdomen. She ended up having to spend several days in the trauma intensive care unit with an open abdomen, had to come back to the operating room multiple times to get a wash out, to clean out more of the infected debris. And at the end, her abdomen was reconstructed with a mesh and closed. This all started with a benign mass. This was not even a cancer case. The mass, if she had been able to seek care several months prior, would have been a no brainer. She would have had laparoscopic surgery and she would have gone home the same day. Her recovery, probably to six to eight months after a surgery like this. That’s important to remember to seek care. And of course, this is no fault of the patient, but to seek care when the symptoms are abnormal and persistent for you.