ANOTHER FRIDAY ON CALL IN SURGERY

Setting: small semi-urban South African hospital. Shortly after month-end. Admissions over a 12 hour period.
  1. 1.
    Teenager two weeks post-assault with blunt object
    Now persistent headache and dizziness. CT normal.
  2. 2.
    20-something female appendicitis
    Pregnancy test negative. Suspected PID but gynaes disagreed. Took her to theater for an appy: found an adnexal abscess.
  3. 3.
    35 yo male 1 week post stab chest
    Actually saw him last week and put in his chest drain (SURGICAL ADMISSIONS ON A HALLOWEEN FRIDAY NIGHT). He was later discharged but returned with recurring symptoms. Xray revealed haemothorax. New ICD placed. >1.5l blood drained instantly.
  4. 4.
    5 yo referred to us as "acute appendicitis"
    ... But actually just a case of fecal loading. 😱😝
  5. 5.
    Young male with bacterial peritonitis
    End stage renal failure and self-administered peritoneal dialysis. Referred as "strangulated hernia" but he didn't have one.
  6. 6.
    6 month baby with depressed skull fracture
  7. 7.
    Elderly female with massive plantar melanoma
    Pedunculated, 10x5x5cm, surrounding tissue cellulitic. Declined amputation since 2013. Now agrees.
  8. 8.
    Thirties male hit with a rock
    Depressed compound skull fracture
  9. 9.
    35yo PVA
    Reduced power LHS; normal CT brain.
  10. 10.
    16yo skull vs rock
    GCS 13/15. Neck stiffness. Depressed compound skull fracture with large frontal cerebral contusion.
  11. 11.
    14 month male "query paraphimosis"
    Not paraphimosis at all but actually just a mild balanitis. I'm beginning to realise that too many people struggle with phimoses, paraphimoses, etc.
  12. 12.
    Middle aged male with renal calculi
  13. 13.
    Wood fire burns
    30% partial thickness burns including inhalation burns. Intubated and admitted to high care.
  14. 14.
    Teenager stabbed in ear
    Downward stab through the tragus into the neck with a long knife. Zone 2-3 injury. Neck haematoma with associated dysphagia. Not rapidly expanding. Urgent CT angio followed by formal wound exploration.
  15. 15.
    Teenager with lower GI bleed
    Also had the worst seborrhoeic dermatosis I've seen. Also newly diagnosed with HIV. After lengthy work up assessed him as dysentery and referred to the physicians.
  16. 16.
    Acute appendicitis
  17. 17.
    Partial bowel obstruction
    In a suspected intra-abdominal malignancy.
  18. 18.
    Psoas abscess
  19. 19.
    Stab chest x7
    Multiple stab wounds anterior and posterior thorax; one quite low posterior at T12. Right haemothorax, left pneumothorax. Bilateral chest drains inserted and taken for exploratory laparotomy.