Operating on little children has always made me nervous and it has been no exception here in Ethiopia. We’ve recently been faced with two babies with congenital abnormalities of the anus. (Yes, I know I talk about lots of gross and embarrassing body parts… but, hey, I’m a general surgeon. What do you expect? Just be thankful I’ve omitted the pictures.)

I operated on the first one around five months ago, a week or two after his birth. His anus had failed to form properly and he had a tiny, abnormal opening just in front of the normal location of the anus. Technically, this is called an imperforate anus with a perineal fistula. He was quite sick from the obstruction and we had to perform a colostomy to let him recover. He was now back in the hospital and ready to have his anus repaired. Not only have I never done this, I’ve never even seen it done… not in person anyway. I’ve watched a video, though. Using some advice from a pediatric surgeon with PAACS down in Kenya, we operated on the boy yesterday. By God’s grace, we were able to open him up and create an anus in the proper place. Assuming he recovers well from this, we will reverse his colostomy in a month or so.

The second child with imperforate anus came to our clinic last Friday. She was nearly six months old and this was the first time she had been taken to the doctor… truly amazing. Her anus had also failed to form but she had formed an abnormal opening into her vagina (sorry, more embarrassment). The amazing thing is she had survived six months like that and had actually gained nearly normal weight. I knew this repair would be much trickier than the previously described boy so we questioned the parents about going to Addis Ababa where there is one pediatric surgeon. It quickly became evident they could never do that. Even though she had survived six months, I didn’t think she would make it very long without a repair so I decided to give it a go. She too would need a colostomy first, followed by a definitive repair. So we got the admission process started and I assumed (big mistake) that she would be put in the hospital. I found out the next morning that they had left for home, stating they didn’t have enough money for admission. My heart breaks because we could have easily cared for her through the benevolent fund if I had known. I’m praying she will come back.

We operated on yet another one year old child today with yet another coffee bean in her airway. This one ended up being quite a bit more difficult. Through a combination of bronchoscopy (a flexible scope looking in the airway) and a tracheotomy (surgical hole in the airway), we were able to get it out but it was quite difficult. Since we have no means to actually do anything through the scope except look, we still had to perform the standard hanging-upside-down-and-pound-the-back routine to dislodge the bean but this time it slipped above our tracheotomy and got stuck there. Dr. Aarsland, our anesthesiologist, was ultimately able to shove it down to our surgical site with the scope so we could pluck it out. Cold sweat dripping down my back, I mentioned to him at the conclusion that I hate this procedure.

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