So, it turned out to be another busy week in the ‘hood. Despite the searing heat and humidity, we at XYZ Hospital did not see any major INCREASE in our normal incidence of gunshot wounds and Level One Trauma incoming wounded. What we did see was more blunt trauma (2 broken jaws and 1 nasal fracture, all 3 from fist fights!), 2 ruptured cerebral aneurysms, and almost 10 miscarriages (I say almost because one turned out to be a ruptured ectopic pregnancy, and she needed a laparoscopy instead of a dilatation and evacuation of uterine contents).
But the really big case of the week, and I do not use those words LIGHTLY, was the radical panniculectomy that was performed on the 300 kg human being. For some quick math, 300 kg would be about 670 pounds avoirdupois.
Panniculus is hanging abdominal tissue, as you see in the above photo (which is not our patient, as our patient’s panniculus was huger than this, and I am not lying). It can develop as the result of pregnancy, large weight loss, or as a consequence of morbid obesity. The tummy tuck that we did this week was necessitated due to an infarcted panniculus. Our patient’s belly hung below the knees and had become necrotic due to its sheer weight and chronic infections. It was estimated to weigh about 130 POUNDS, which at this point is as big as me.
We needed to push two OR tables together to hold all of this patient’s mass, and still there was panniculus hanging over the edge of the table. It was absolutely massive. If I was allowed, I would have taken a cell phone photo to share with you.
Of course, the patient’s airway looked like a potential disaster, so the patient was fiberoptically intubated awake without incident after the administration of some IV sedation and some local anesthetic to the throat. Several large bore IVs, a central line, and an arterial line were also placed.
The procedure was uneventful and took several hours. This patient did quite well. The severed panniculus had to be carried out of the room (all specimens removed from patients are sent to pathology) wrapped in a body bag. It really had taken on a life of its own. May it rest in peace, and may the patient now enjoy a more comfortable life.
Oh, I almost forgot to tell you - it took no less than 10 people to move this patient from the bed to the OR table. After surgery, it took only 6 people to lift the patient back to the bed.