Curbside Consult Thread

[cougjunkie]

I was doing a low back lipoma excision today, which is maybe the easiest and least exciting general surgery out there. When I took the lipoma out, there was a bulb of fat left, which seemed to be coming from a deeper layer. I was able to palpate a small hole, and the next thing I know, my finger is in his pelvis. He had a lumbar hernia and I was seeing his retroperitoneal fat. Not a big deal to fix, but a good example of even the most simple-seeming case being more than you bargained for.

No clue what this is but it sound disgusting.

[doctorcoug]

I was doing a low back lipoma excision today, which is maybe the easiest and least exciting general surgery out there. When I took the lipoma out, there was a bulb of fat left, which seemed to be coming from a deeper layer. I was able to palpate a small hole, and the next thing I know, my finger is in his pelvis. He had a lumbar hernia and I was seeing his retroperitoneal fat. Not a big deal to fix, but a good example of even the most simple-seeming case being more than you bargained for.

Holy crap. That will keep you on your toes. Were you in clinic or the OR?

[ERCougar]

I was doing a low back lipoma excision today, which is maybe the easiest and least exciting general surgery out there. When I took the lipoma out, there was a bulb of fat left, which seemed to be coming from a deeper layer. I was able to palpate a small hole, and the next thing I know, my finger is in his pelvis. He had a lumbar hernia and I was seeing his retroperitoneal fat. Not a big deal to fix, but a good example of even the most simple-seeming case being more than you bargained for.

So was the lipoma actually just retroperitoneal fat? That's crazy.

[San Juan Sun]

Holy crap. That will keep you on your toes. Were you in clinic or the OR?

O to the R.

Today's victims: two colonoscopies, one EGD, lumbar hernia repair, removal of foreign bodies from a skateboarders arm (four chunks of glass), and a needle localized breast biopsy.

And all done by noon.

[San Juan Sun]

So was the lipoma actually just retroperitoneal fat? That's crazy.

It was both. A well delineated lipoma adjacent to a possibly asymptomatic hernia.

[smokymountainrain]

I love this thread. I don't understand shit, but for some odd reason it's very entertaining.

[San Juan Sun]

86 yo female with rectal cancer, surgeon advocates for resection and adjuvant chemoradiation. Family thinks it will go away, and refuses any intervention or any follow up care.

Patient is lost to follow up for 8 months.

Family brings patient back, complaining that the rectal mass is now completely protruding out of the anus, and it bleeds frequently. They are upset, very upset, that nothing was done.

Thankfully, the patient is pleasantly demented, and is still a candidate for palliative (but not curative) resection.

[doctorcoug]

86 yo female with rectal cancer, surgeon advocates for resection and adjuvant chemoradiation. Family thinks it will go away, and refuses any intervention or any follow up care.

Patient is lost to follow up for 8 months.

Family brings patient back, complaining that the rectal mass is now completely protruding out of the anus, and it bleeds frequently. They are upset, very upset, that nothing was done.

Thankfully, the patient is pleasantly demented, and is still a candidate for palliative (but not curative) resection.

Had a very similar issue today. Proves the importance of good documentation.

[CardiacCoug]

Family brings patient back, complaining that the rectal mass is now completely protruding out of the anus, and it bleeds frequently. They are upset, very upset, that nothing was done.

Thankfully, the patient is pleasantly demented, and is still a candidate for palliative (but not curative) resection.

This is a big problem that we run into with very elderly people with heart issues too. You have family members who say, "Don't do anything, just let her die." And that would be a great option in a 90-year old if he/she were going to die. The problem is that they don't die -- they just linger on for months or even years in agony or with severe disability. You end up having to do something just to preserve quality of life to some degree even though obviously you won't extend life very much usually in a 90-year old no matter what you do.

[creekster]

This is a big problem that we run into with very elderly people with heart issues too. You have family members who say, "Don't do anything, just let her die." And that would be a great option in a 90-year old if he/she were going to die. The problem is that they don't die -- they just linger on for months or even years in agony or with severe disability. You end up having to do something just to preserve quality of life to some degree even though obviously you won't extend life very much usually in a 90-year old no matter what you do.

The doctors tarsted telling my gradnmother this when she was 90. That was almost 9 years ago and she is still going strong. You never know.

[San Juan Sun]

From the "Interesting stuff I find in my patient's pockets" file:

A 30-something yo male just got shot in the leg. We routinely take off the patient's clothes to examine them, and put their stuff in a property bag. Sometimes we find interesting things. Tonight's haul:

a pocket Webter's dictionary
two condoms
three old baseball cards (Cal Ripken, Ivan Rodriguez, Nolan Ryan)

I'm not sure how to make sense of all this, and how he ended up getting shot, but it sure is interesting.

[ERCougar]

From the "Interesting stuff I find in my patient's pockets" file:

A 30-something yo male just got shot in the leg. We routinely take off the patient's clothes to examine them, and put their stuff in a property bag. Sometimes we find interesting things. Tonight's haul:

a pocket Webter's dictionary
two condoms
three old baseball cards (Cal Ripken, Ivan Rodriguez, Nolan Ryan)

I'm not sure how to make sense of all this, and how he ended up getting shot, but it sure is interesting.

My first GSW as a resident. Young black male shot in the leg. Do the rectal and feel some little...crunchiness. I think it's just some dried crap, but it feels a little different. A little more investigation and I pull out a condom with little crack rocks in it. Yes...crack in his crack. Baboom....CHING!

[hostile]

From the "Interesting stuff I find in my patient's pockets" file:

A 30-something yo male just got shot in the leg. We routinely take off the patient's clothes to examine them, and put their stuff in a property bag. Sometimes we find interesting things.

I remember rolling a trauma patient, GSW to the chest/abd and having his loaded 9mm slip out of his pocket and land on my foot.

[smokymountainrain]

My first GSW as a resident. Young black male shot in the leg. Do the rectal and feel some little...crunchiness. I think it's just some dried crap, but it feels a little different. A little more investigation and I pull out a condom with little crack rocks in it. Yes...crack in his crack. Baboom....CHING!

They don't pay you guys enough.

[San Juan Sun]

Calling someone to tell them their spouse has died (very unexpectedly) is heartbreaking.

I could hear American Idol in the background as the spouse fumbled for words. And all I could think about was that one minute he was watching TV, and then the phone rings and his life is ripped apart.