Monday, March 25, 2019

Video reveals ignorance, not negligence: Doctors

Tribune (Excerpts): A viral video shot inside Kashmir valley’s main tertiary care hospital showed a patient with his abdomen slit open and attendants pleading for help and alleging doctors of negligence. An inquiry was ordered immediately. 

The complete picture of the video, however, reveals it was the ignorance of the attendants and not the negligence of the doctors.

The patient, suffered from wound dehiscence and also peritoneal carcinomatosis, a rare type of cancer that can develop when gastrointestinal cancer spread and cause tumors to grow in the thin layer of tissue that lines the abdomen and covers most of the abdominal organs.

In such cases, once the wound has opened up (dehiscence), a time gap is given before secondary suturing.

Wound dehiscence 

Wound dehiscence or opening of the wound along the line of incision, occasionally occurs in surgical wounds postoperatively despite a carefully performed layered closure. It is common in the first week after the surgery.

The risk of wound dehiscence is increased by factors such as wounds in high-tension areas (superior trunk, proximal upper extremities), older age, malnutrition, anemia, diabetes, intra-abdominal infection, poor patient compliance to postoperative advice, drugs such as systemic corticosteroids.

Surgical wounds that heal by primary intention are healed 5-10% after one week and after 1 to 2 months, they are 50% healed. About 80% of normal skin strength is regained several months after the surgery. Hence, it is important to avoid stress during the first few weeks after the surgery.

Even mild activity may adversely affect the strength of the wound sutures. Patients should be advised to limit lifting no more than 15 pounds for two weeks after surgery and only gradually increasing activity as tolerated. Walking can be continued within a day or two of surgery. Elevation of leg to decrease edema in lower extremity wounds may put stress on the healing wound.

What is carcinomatosis?

Carcinomatosis is a condition in which cancer is spread widely throughout the body, or, in some cases, to a relatively large region of the body. It is also called carcinosis.

Peritoneal carcinomatosis

Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity called peritoneal carcinomatosis. It is often associated with disease progression and poor prognosis.

Peritoneal carcinomatosis has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer. Moreover, overall survival in these patients is usually only slightly influenced by systemic chemotherapy. Hence, peritoneal carcinomatosis is traditionally regarded by the surgeon as a terminal condition.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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