Dr Fragen in the operating room

Cuban flu


Here’s my personal take on Fidel Castro’s recovery.
I’ve finally gotten [some information][1] to be able to make a comment upon. Apparently, Mr. Castro initially suffered from [acute diverticulitis][2]. From the BBC, who is quoting the Spanish newspaper *El Pais*, Mr. Castro had the following procedures and problems.
> * Part of intestine removed – colon connected to rectum
> * Cleaning and draining of infected area
> * Prosthesis implanted
This is 3 separate operations and there are some reports that he has had seven operations thus far. First, I think Castro’s first surgery should never have reconnected his colon to his rectum. In surgery, and especially when operating for infection, one of the primary tenets is *source control*. Source control refers to the removal of problem, in most cases contamination or bleeding are the problems. There is a well described operation called a [*Hartmann’s Procedure*][3] whereby the involved segment of colon is removed and the patient is given a temporary colostomy. My bet is that someone close to Castro or even Castro himself told the surgeon **not** to give him a colostomy. All subsequent problems are related to this poor decision.
He clearly had a continued infection and even in the presence of this they implanted a mesh. The mesh was likely to close the abdominal wall. **Never** use mesh when there is any consideration of infection in the vicinity.
Under normal circumstances an 80 year old should have recovered quite well from this operation and should even have been able to have their colostomy reversed (colon hooked back up to rectum) again.
All this reminds me of the old joke about Soviet leaders who “got the flu” and then Soviet television would be playing martial music just prior to announcing the leaders death.
> On Monday, an unnamed Latin American diplomat told the Reuters news agency that “Fidel has problems with his stitches healing”.
Somehow I think they’re understating the problem. Bottom line — it pays to do the right operation the first time.
[1]: http://news.bbc.co.uk/2/hi/americas/6265739.stm
[2]: http://en.wikipedia.org/wiki/Diverticulitis
[3]: http://en.wikipedia.org/wiki/Hartmann_procedure