5 December 2023
My Night on Call in India
2 May 2022
Tapan Patel MBBS
Baroda Medical College, India
There’s a story and there’s a moral of the story. I was in my intern year of M.B.B.S on duty for 24-hour emergency/trauma surgery shift. It was 2am. Me, my supervising PGY-2 surgery resident and radiology residents were in their 18th hour of duty. Then arrives a patient, a 65-year-old male with nausea, vomiting, constipation and severe abdominal pain. As per my routine, I approached him, took his vitals, and reported it to my resident who had worse GCS than the patient (due to the workload of course!). The resident got up, examined the patient’s abdomen and suspected that he had intestinal obstruction. He told me to send the patient’s samples for blood work and take him to the radiology residents for X-ray and an ultrasound. Abdominal X-ray showed multiple air-fluid levels in the bowel suggestive of obstruction. The ultrasound suggested something similar.
I came back with the radiology reports. The resident saw them, called the attending, informed that laparotomy and exploration was needed as radiology reports couldn’t find the cause. The attending asked to prepare the patient for the surgery. I went the patient to catheterise his bladder and as soon as he removed his underwear, I saw a huge mass in the right groin, filled with material with putty-like consistency (I even did indentation). This was at 3:30 A.M. and the patient had been seen by at least four doctors, but his groin was being exposed for the very first time!
This patient had an obstructed inguinal hernia. I rush back to the resident with mixed feelings. One of them was happiness, as me, an intern, found the cause of obstruction. Another was anxiety regarding what would the resident do to convince the potentially angry attending once he found out. The resident eventually had to inform the attending (and I could overhear the increased volume from the earpiece of the phone). The patient was then managed appropriately and successfully.
It is sad not, only because we have to work for long hours but also because we tend to skip basic physical examination and rely on other modes of investigations. Such errors can harm the patients. Hence, it is extremely important to do proper physical examination in any patient. As I mentioned in the beginning, there has to be a moral of the story, and the moral is: ALWAYS CHECK THE GROIN OF A PATIENT WITH ABDOMINAL SYMPTOMS.
Comment: Always check the groin
Part of the charitable activity of the Society, BJS Academy is an online educational resource for current and future surgeons.
The Academy is comprised of five distinct sections: Continuing surgical education, Young BJS, Cutting edge, Scientific surgery and Surgical news. Although the majority of this is open access, additional content is available to BJS subscribers and strategic partners.