MEDICOS Nicaragua 2015: CASE 1 GYN Surgery

CASE 1: GYN Surgery

We arrived to Nicaragua not knowing what quite to expect. With help of our preceptor and GI Surgeon, Dr Lawson, we met the director of Surgery who then allowed us complete access to observing all surgeries at the hospital- that's what we did our entire first week.

Wednesday May 13th 2015:

After observing rounds at 7am, Kristiana and I went down to the surgery wing of the hospital and were very excited to observe what we thought was a c-section.

They made their usual 4 inch vertical midline incision below the umbilicus. They then separated the muscle, pulled the incision open from both sides, shook their heads in awe, and expanded the 4in incision to 7 or 8 inches.

We peeked in and saw what appeared to be a well-vascularized smooth fluid filled mass which we initially thought was the amniotic sack, then we realized they hadn't cut through the uterus yet. Strange. Given how large her abdomen was, we asked if the woman was having twins, "No bebé" the doctor replied. No bebé? Entonces, que es? "es un mega quiste" she replied.

MEGA cyst!

They reached their hands in and pulled out what could only be described as a well vascularized extra large 20 pound water balloon. Impressive.

Take a look at the photos/videos
 below and take a guess as to what kind of cyst it is. Benign or malignant? Teratoma? Serous? Hemorrhagic?

How did it get so large? We were unable to talk to the patient, however, we know that she waited until she was in a lot of pain before coming in. Unfortunately access to care is extremely limited and especially in rural communities. We'll post more about our experiences in rural clinics and house visits soon.

See comments below for the answer. Also, let us know what you think about this case =]

Cheers,

Diana <3

Ps- probably wouldve looked like this google image (but even bigger) on imaging: