Pyloric Stenosis

A 10 week old baby girl was admitted to the hospital for vomiting, dehydration and failure to thrive. She was still only 3.5 Kg (about 7lb, 11 oz)! From the history given by the mother, there were no problems with the birth. About one week later, however, the baby started to vomit. She would nurse well, then vomit and want to nurse again. She had been admitted to another district hospital for 2 weeks, but saw no improvement, so she was brought to BMC.

We resuscitated her by giving her fluids intravenously and monitoring her ability to make urine.

On exam, her abdomen was soft, not severely distended and no masses were felt. We followed up the exam with an ultrasound. I found that her muscle around the pylorus (the special channel between the stomach and the first part of the small intestines) was much larger than it should be. The pathway between the two organs was limited to a trickle.

The condition is called Hypertrophic Pyloric Stenosis. It is usually found by week 4-6 after birth, but sometimes, diagnosis is delayed around here.  The problem arises when the pyloric muscle grows very thick and essentially blocks the pyloric channel, thereby causing the baby to vomit – even projectile vomiting.

** WARNING: GRAPHIC IMAGES **
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Drilling Bone for Granulation Tissue

A boy was bit by a snake on the shin and the bite developed into a large abscess with significant loss of tissue. As the healing began, about 75% of the anterior tibia was exposed. The infection was now gone, but now the problem was healing an exposed bone.

As wounds heal, granulation tissue covers the wound. Colloquially, it is called “proud flesh.”

** WARNING: GRAPHIC IMAGES **
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My First Day… 11 Years Ago Today

Eleven years ago today was Heidi’s first day of clinic at BMC. It’s fun to go back and read her first impressions on October 8, 2007.

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Pastor Appreciation in Sumnibooma#1

Yesterday was Pastor Appreciation Sunday at Sumnibooma#1, one of the village churches on my preaching circuit. After I preached, the kind folks there presented me with a brand new smock. The church also gave their pastor George a new mattress and his wife received some cloth to make new clothes for the family. I’m always humbled by the generosity of Ghanaians. Showing appreciation is such an important part of their culture and something I’m always reminded to strive for.

We were also excited to see the pastor’s daughter again. A couple months ago, she fell out of a shea nut tree and had a horrible broken arm. Heidi took care of it at the hospital, set it and put it in a cast. Yesterday we got to see her with the cast off and her arm has healed perfectly. Praise the Lord!

As per usual, Heidi also did some impromptu post-church service consultations. She can’t really treat anyone right there on the spot, but often she can save them a trip to the hospital if the problem isn’t serious or convince them to come if it is!

The baby she is examining in the photo below was stung by some insect in his arm over a week ago. The mother was worried about the mark but Heidi assured her it was healing well and she didn’t need to go to the hospital or buy any more medicine.

Breast Cancer Mass

A woman in her mid-thirties came to BMC with a large tumor of her left breast which she said had been growing for only 5 months. The mass was so large, in fact, that she wore a cloth like a sling to help manage its weight. There were no external wounds. The nipple and areola (the area around the nipple) were flattened and stretched out. She had enlarged lymph nodes in the axilla (armpit). She had no difficulty breathing and her lungs sounded clear with good air entry. She had no signs of distant metastatic disease.

I performed an ultrasound and found that inside were areas of solid mass and pockets of fluid. Clinically, the tumor appeared to be what is called a Phyllodes tumor or cystosarcoma phyllodes. These tumors can grow very rapidly. Some of these tumors are benign, some are malignant. Either way, the only treatment I could offer was a mastectomy.

After discussing the risks of surgery versus the benefit of a mastectomy, the patient agreed.

** WARNING: GRAPHIC IMAGES **
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Encounters with Ghana’s (Not So) Sexy Spanish Fly

This post started out as a simple post about the annoying blister bugs we have around our home in northern Ghana. On many occasions they have caused horrible blisters on Heidi and myself and I wanted to learn more about them. I got lost for hours following rabbit trails as I research the subject and it just continued to get more and more interesting. Nothing is ever as simple as it seems. And I kind of love that.

Northern Ghana’s Green Blister Beetle

Lytta vesicatoria

My first step is always to find out what the locals call it. No one I talked to was familiar with the phrase “blister bug.” This particular bug – actually a “green blister beetle” – is known locally as abdulatanka. That’s not a word in an indigenous Ghanaian language but Pidgin English for “Abdullah’s Tanker” – a reference to a Muslim guy driving a fuel tanker. Why? Because the green blister beetle leaks a toxic fluid and has a tanker-shaped back side. Plus the stereotypical big-rig driver in Ghana is a Muslim man with an Arabic name.

There’s a whole scientific family of blister beetles name Meloidae with around 3000 species. One genus in that family is Lytta and the offending blister bug in our encounters seems to fall in that group. Read More

Intussusception

In the past several months, I have operated on three six-month old babies for intussusception. Intussusception occurs when the bowel telescopes into itself and cannot exit back out again. Once the bowel is stuck, it begins to swell, the blood supply to that portion of the intestines becomes compromised and it can lead to strangulation of the bowel.

In infants, this disease process often occurs when the lymph nodes become inflamed around the junction between the small and large intestines. The infant has episodic abdominal pain, bloody-mucoid stool, and sometimes an elongated mass can be felt through the abdominal wall. The ultrasound finding is called a “target sign” due to the multiple layers of intestines and the edema in the bowel walls.

Sometimes, if intussusception is caught early enough, a pressurized enema (given by interventional radiologists) is all that is needed to reduce the bowel back out. Here, we don’t have that specialty, therefore, surgery is the only option for treatment. Sometimes, it only requires a little manual pressure to push the bowel out, but more often than not, a resection of the affected bowel is required.

** WARNING: GRAPHIC IMAGES **
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