when the superintendent of the referring hospital phoned, he said;
"there is something funny on the x-ray!" what exactly the funny thing was he could not tell me. he could tell me what it was not. it was apparently not free air in the peritoneal cavity (indicating perforation of some part of the intestinal canal) and it was not air fluid levels in the small bowel (indicating obstruction). it was simply something funny. he also mentioned the abdomen was acute (a surgical term pretty much meaning an operation was indicated). i told them to send.
when the patient arrived, the abdomen was acute as they had said. there was also no free air in the abdomen as they had said. but i found that i did not burst into spontaneous laughter when i reviewed the x-rays. it was not as funny as the referring doctor had said.
what it did show was a full colon. but it was the most loaded colon i've ever seen on x-ray. usually feces is a mix of solid and gas, but this showed only solid matter filling the entire colon. i asked the patient when last she had passed a stool.
"i don't pass stools." was her simple factual reply. i wanted to ask her if she thought it was normal to not pass stools and where did she think all the stuff that she was throwing in above was going. but it was late and i wanted to get the operation behind me. so i tasked the junior doctor with getting the patient to theater and waited for his call.
i opened in the midline. there was a perforation in the sigmoid caused by pressure inside the lumen of the bowel, causing necrosis of the retroperitoneal region. that was something i've dealt with many times. but what was 'funny' was the content of the colon. the entire colon was filled with what looked like feces but was as hard as rock. i spent most of the operation milking this stuff out and dumping it in a large basin. in the end i had removed about 4kg of rock hard feces as well as the sigmoid. it was not fun.
while i was evacuating this colon i had time to reflect. i couldn't help once again considering the fact that this woman had just accepted that she did not pass stools as normal. she had not sought help until the pressure had ruptured her colon and endangered her life.
yes indeed, there is no pill for stupidity. . . you must operate.