Elective appendicectomy

Icemancometh

I swear I'm not trying to re-open a closed thread! I justed wanted to answer Traumadoc, and that one was closed. I remember a discussion I had with a surgical SpR a while back about this topic. Apparently people going on long journeys to completely inaccessible areas do it. It really boils down to astronauts, and military bases in the Antarctic. I always thought the idea was cool. :pac:

AndrewJD

Icemancometh wrote: »

I swear I'm not trying to re-open a closed thread! I justed wanted to answer Traumadoc, and that one was closed. I remember a discussion I had with a surgical SpR a while back about this topic. Apparently people going on long journeys to completely inaccessible areas do it. It really boils down to astronauts, and military bases in the Antarctic. I always thought the idea was cool. :pac:

So has an appendix ever been into space?

Icemancometh

AndrewJD wrote: »

So has an appendix ever been into space?

No idea. I think they first realised it was a problem when a Russian scientist got appendicitis while on an Antarctic base. He was a surgeon, but the only one on the base. So he performed an autoappendicectomy. After that, I think they just took precautions.

His name is Leonid Rogozov, and his wikipedia article has some scant info on it. There's a case report on the BMJ website, but it's behind a paywall. I googled the topic too, can't see anything backing up my old SpR's assertion though.

MrCreosote

I thought the risk of complications post-appendicectomy (adhesions/bowel obstruction and the like) was higher than the risk of appendicitis, and it's no longer indicated for remote travel?

Traumadoc

Yes and there was the case were the doctor trapped in Antarctic got Breast cancer and had to self medicate or something, but I don't think they advocate having mastectomies prior to long periods of isolation.


I was just interested why this guy wanted his appendix out, perhaps he had been refused in Ireland and was looking to go overseas to get it done.


I once had a patient who did not like his leg. Surgeons refused to amputate.

So he comes into our hospital ( overseas) after putting is leg in dry ice for four hours. He got his wishes as a result.

0lddog

What a waste.

Nothing I like more than a bit of leg beef

Did ye not even attempt to transplant it to someone in need ?

sillymoo

The only time I have heard of an elective appendectomy is during a Ladds procedure for malrotation.

ThatDrGuy

Thanks for the article recommend. I have access to the BMJ so I read it.
I would like to officially recommend Leonid Rogozov for the boards.ie balls-of-steel award. Some choice bits:

18.30. I’ve never felt so awful in my entire life. The building is shaking like a small toy in the storm. The guys have found out. They keep coming by to calm me down. And I’m upset with myself—I’ve spoiled everyone’s holiday. Tomorrow is May Day. And now everyone’s running around, preparing the autoclave. We have to sterilise the bedding, because we’re going to operate.“20.30. I’m getting worse. I’ve told the guys. Now they’ll start taking everything we don’t need out of the room.”


As well as Rogozov, the meteorologist Alexandr Artemev, the mechanic Zinovy Teplinsky, and the station director, Vladislav Gerbovich, were selected to undergo a sterile wash. Rogozov explained how the operation would proceed and assigned them tasks: Artemev would hand him instruments; Teplinsky would hold the mirror and adjust the lighting with the table lamp; Gerbovich was there in reserve, in case nausea overcame either of the assistants. In the event that Rogozov lost consciousness, he instructed his team how to inject him with drugs using the syringes he had prepared and how to provide artificial ventilation. Then he gave Artemev and Teplinsky a surgical wash himself, disinfected their hands, and put on their rubber gloves for them.


Operation began at 2 am local time. Rogozov first infiltrated the layers of abdominal wall with 20 ml of 0.5% procaine, using several injections. After 15 minutes he made a 10-12 cm incision. The visibility in the depth of the wound was not ideal; sometimes he had to raise his head to obtain a better view or to use the mirror, but for the most part he worked by feel. After 30-40 minutes Rogozov started to take short breaks because of general weakness and vertigo. Finally he removed the severely affected appendix. He applied antibiotics in the peritoneal cavity and closed the wound. The operation itself lasted an hour and 45 minutes Partway through, Gerbovich called in Yuri Vereshchagin to take photographs of the operation ( crazy photograph - wow )


Gerbovich wrote in his diary that night:
“When Rogozov had made the incision and was manipulating his own innards as he removed the appendix, his intestine gurgled, which was highly unpleasant for us; it made one want to turn away, flee, not look—but I kept my head and stayed. Artemev and Teplinsky also held their places, although it later turned out they had both gone quite dizzy and were close to fainting . . . Rogozov himself was calm and focused on his work, but sweat was running down his face and he frequently asked Teplinsky to wipe his forehead . . . The operation ended at 4 am local time. By the end, Rogozov was very pale and obviously tired, but he finished everything off.”


My poor assistants! At the last minute I looked over at them: they stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else.


There is a lot more, I would highly recommend people read it. I can't post more as it might offend BMJ copyright...

Icemancometh

ThatDrGuy wrote: »

Thanks for the article recommend. I have access to the BMJ so I read it.
I would like to officially recommend Leonid Rogozov for the boards.ie balls-of-steel award. Some choice bits:

18.30. I’ve never felt so awful in my entire life. The building is shaking like a small toy in the storm. The guys have found out. They keep coming by to calm me down. And I’m upset with myself—I’ve spoiled everyone’s holiday. Tomorrow is May Day. And now everyone’s running around, preparing the autoclave. We have to sterilise the bedding, because we’re going to operate.“20.30. I’m getting worse. I’ve told the guys. Now they’ll start taking everything we don’t need out of the room.”


As well as Rogozov, the meteorologist Alexandr Artemev, the mechanic Zinovy Teplinsky, and the station director, Vladislav Gerbovich, were selected to undergo a sterile wash. Rogozov explained how the operation would proceed and assigned them tasks: Artemev would hand him instruments; Teplinsky would hold the mirror and adjust the lighting with the table lamp; Gerbovich was there in reserve, in case nausea overcame either of the assistants. In the event that Rogozov lost consciousness, he instructed his team how to inject him with drugs using the syringes he had prepared and how to provide artificial ventilation. Then he gave Artemev and Teplinsky a surgical wash himself, disinfected their hands, and put on their rubber gloves for them.


Operation began at 2 am local time. Rogozov first infiltrated the layers of abdominal wall with 20 ml of 0.5% procaine, using several injections. After 15 minutes he made a 10-12 cm incision. The visibility in the depth of the wound was not ideal; sometimes he had to raise his head to obtain a better view or to use the mirror, but for the most part he worked by feel. After 30-40 minutes Rogozov started to take short breaks because of general weakness and vertigo. Finally he removed the severely affected appendix. He applied antibiotics in the peritoneal cavity and closed the wound. The operation itself lasted an hour and 45 minutes Partway through, Gerbovich called in Yuri Vereshchagin to take photographs of the operation ( crazy photograph - wow )


Gerbovich wrote in his diary that night:
“When Rogozov had made the incision and was manipulating his own innards as he removed the appendix, his intestine gurgled, which was highly unpleasant for us; it made one want to turn away, flee, not look—but I kept my head and stayed. Artemev and Teplinsky also held their places, although it later turned out they had both gone quite dizzy and were close to fainting . . . Rogozov himself was calm and focused on his work, but sweat was running down his face and he frequently asked Teplinsky to wipe his forehead . . . The operation ended at 4 am local time. By the end, Rogozov was very pale and obviously tired, but he finished everything off.”


My poor assistants! At the last minute I looked over at them: they stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else.


There is a lot more, I would highly recommend people read it. I can't post more as it might offend BMJ copyright...

Thanks for that. I'm gonna read it in the library tomorrow.

Icemancometh

Traumadoc wrote: »

Yes and there was the case were the doctor trapped in Antarctic got Breast cancer and had to self medicate or something, but I don't think they advocate having mastectomies prior to long periods of isolation.


I was just interested why this guy wanted his appendix out, perhaps he had been refused in Ireland and was looking to go overseas to get it done.


I once had a patient who did not like his leg. Surgeons refused to amputate.

So he comes into our hospital ( overseas) after putting is leg in dry ice for four hours. He got his wishes as a result.

I can't imagine that the chances of getting appendicitis during, say, a 3 month stay on a space station, would be worth the risk of having surgery. Or even for a longer stay those Mir guys used to do. It was just something a surgeon said off-handedly to me one day I find mildly amusing. Thought I'd share.

opinion guy

Icemancometh wrote: »

I can't imagine that the chances of getting appendicitis during, say, a 3 month stay on a space station, would be worth the risk of having surgery. Or even for a longer stay those Mir guys used to do. It was just something a surgeon said off-handedly to me one day I find mildly amusing. Thought I'd share.

Why limit it to appendix ? There are any number of infections people might get up there that would ordinarily require surgery - hell what if they need a dental extraction? I'm sure if someone gets any kind of serious or even not serious infection up there they f**k copious amounts of powerful space-antibiotics at it.

Icemancometh

opinion guy wrote: »

Why limit it to appendix ? There are any number of infections people might get up there that would ordinarily require surgery - hell what if they need a dental extraction? I'm sure if someone gets any kind of serious or even not serious infection up there they f**k copious amounts of powerful space-antibiotics at it.[/QUOTE

Did some quick searching on this one. The only source that's not more than the hearsay I can already offer comes from a book called "Trailblazing Medicine." There's a chapter on Interplanetery Medicine, that says "given the seriousness of such an event, the astronauts will probably have their appendices removed before flight." That said, this is talking about a putative journey to Mars, over the course of a couple of years. So in that context, maybe...

Also, as it happens, the page which talks about the appendicectomies, refers to an incident where a Russian cosmonaut self-medicated for a toothache. Apparently they had no contigencies for a medical emergency, so he had to put up with it for two weeks until scheduled re-entry.

RobFowl

That is fascinating ThatGuy
Was a bit wary of this thread tbh but for that alone it's worth reading..

Traumadoc

I am sure you remember the Doctor with Breast cancer in Antarctic

http://en.wikipedia.org/wiki/Jerri_Nielsen

lonestargirl

This article gives a good overview of the comprehensive pre-mission health testing that astronauts underwent for the Apollo mission. There was also extensive monitoring of the physiological changes as a result of being in space.

I was at a conference in Texas that had a local astronaut giving the keynote speech. One of the things that ends an astonauts career is having reached a cosmic radiation exposure that corresponds with a 6% increase in cancer risk. Of course their baseline risk is lower than the average population as they are fit, don't smoke etc.

Dingle_berry

Untreated appendicitis can kill in hours, an infected tooth or cancer you have weeks or months before it would become lethal?

Unless the team surgeon was afraid of having to do the above, or there was no surgeon on the team an elective appendectomy wouldn't be required?
The appendix can be useful eg if you need to have your bladder removed a replacement can be made from your appendix. Imagine throwing it away only to need it for something like that later on…

Ryder

Dingle_berry wrote: »

Untreated appendicitis can kill in hours, an infected tooth or cancer you have weeks or months before it would become lethal?

Unless the team surgeon was afraid of having to do the above, or there was no surgeon on the team an elective appendectomy wouldn't be required?
The appendix can be useful eg if you need to have your bladder removed a replacement can be made from your appendix. Imagine throwing it away only to need it for something like that later on…

sometimes, very rarely, an 'elective appendicectomy' is done to treat cases of chronic right sided pain, where all else has been excluded. I don't think that there is much of an evidence base for that, but it is done.