During this pandemic, surgical decision making has leaned towards being conservative. Being available for patients and seeing them in person makes a huge difference to the final outcomes. Sometimes it’s just a hunch, a gut feeling that it is not what it appears to be. Pain in the right lower abdomen more often than not turns out to be #appendicitis in young patients who are in their thirties. In this case however, something didnt feel right. As is the norm the first impulse was to just manage conservatively, but somewhere something was not fitting in and we evaluated further. A CT scan and a colonoscopic biopsy revealed a rare Non Hodgkin’s Lymphoma involving the distal ileum and the appendix. Much to our chagrin it was also causing recurrent intussusception and that was probably the cause of pain. A #Laparoscopic #RightHemicolectomy was performed and thankfully all is well now. Patient will need to undergo further chemotherapy.
However, I am glad that we didn’t end the story with just an #onlineconsultation. I am glad that we did not opt for #conservative management. I am glad we evaluated further and could offer the right #treatment at the right time. Most importantly, I am glad that the patient was not scared to come to the hospital to seek help. Also most of the times, such cases are taken up for appendicectomy and the tumour is detected post operation. That entails yet another operation. I am happy that we could detect it prior and save additional suffering and one extra surgery for our patient.
There are many lessons to be learnt from this case. There is no doubt that it is a rare presentation of a disease. However, it has also presented at the rarest of rare times when everything is limited in resources. Most importantly fear could have prevented us from taking the right steps. The biggest take home message here is that- “Other diseases are important too and need our attention in equal measure”.
Dr. Aparna Govil Bhasker is an accomplished Bariatric Surgeon and Laparoscopic GI Surgeon. Extremely passionate about her field of specialization. She completed her MBBS and MS in General Surgery in 2006, from Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. Set up in 1967 by none other than the first health minister of India, Ms. Sushila Nayar, MGIMS is deeply rooted in Gandhian ethics. Read more
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