Wednesday, January 17, 2007

Castro Colon Conjecture......
A great deal in the news the past few days about Cuban dictator Fidel Castro's recent encounter with his country's socialist utopian medical system. One piece of information making the rounds is that El Jefe himself ruled out a colostomy.
Fidel Castro himself told surgeons not to perform a colostomy, opting instead for a course of surgery that produced a complication that left the Cuban leader in far worse condition, according to a newspaper report Wednesday.

After removing an inflamed piece of Castro's large intestine in an operation last year, the doctors connected the remainder directly to his rectum, rather than attaching a colostomy bag, El Pais said, quoting two medical sources at Madrid's Gregorio Maranon hospital. The operation failed when a suture burst.

"The Cuban dictator and his advisers are the ones who decided on the surgical technique that has led to the complications," the paper said.
Imagine the conversation, Castro surrounded by his medical team and surgeons:

SURGEON #1: El Presidente, we must remove your colon due to the inflammation. The safest way to do so would be to remove the diseased portion and leave a colostomy.

CASTRO: No. No colostomy. Chicks don't dig the bag.

SURGEON #1: But Maximum Leader.....

CASTRO: Take him away. (Surgeon #1 take out of room, never to be seen again.)

CASTRO (to surgeon #2): What do you think?

SURGEON#2: No colostomy, understood Jefe!!!

While all of what is out there is rumor, Castro sounds as if he has experienced one of the great joys of abdominal surgery, an enterocutaneous fistula:
El Pais said that in December, when Garcia Sabrido visited, Castro had an abdominal wound that was leaking more than a pint of fluids a day, causing "a severe loss of nutrients." The Cuban leader was being fed intravenously, the report said.

As well as "bile duct inflammation":
“In the summer, the Cuban leader bled abundantly in the intestine,” El Pais reported. “This adversity led him to the operating table, according to the medical sources. His condition, moreover, was aggravated because the infection spread and caused peritonitis, the inflammation of the membrane that covers the digestive organs.”

The recovery from the first operation, in which part of his large intestine was extracted and the colon was connected to the rectum, did not go well. The link broke and he released feces into the abdomen that caused another peritonitis, the report said.

A second operation to clean and drain the infected area also failed, the paper said. He was then hit with inflammation of the bile duct, an illness which has a 80 percent mortality rate, el Pais said. A prosthesis made in South Korea was implanted and failed and later was replaced with one made in Spain.
I have also read that the "Spanish stent" was some sort of "experimental artificial bowel" or some such other. The coverage also seems to use the term "diverticulitis" in both the usual medical sense and also to mean "diverticulosis" as well. The reports of intestinal bleeding seem to go along more with the diagnosis of diverticulosis, than diverticulitis. But there is also mention of "infection spread" and "peritonitis", terms more consistent with diverticulitis. Intractable bleeding from diverticulosis is treated with surgery if other measures fail. Because blood in the bowel serves as a cathartic, and there is no evidence of infection, the argument for primary repair can be made. In an 80-year old, especially one who has had multiple transfusions and may be in shock, a Hartmann's Operation would be my procedure of choice. In the case of diverticulitis, depending on the amount of contamination, some advocate primary repair and the use of on-table colonic lavage.

Regardless, it is doubtful we will ever know how Castro ended up this way.

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