No second choice

(This is a purely medical post. There are images which can be quite revolting to most of you. User discretion advised)

Couple of days back, we had a very interesting patient in labour room. RD, a 30 year old mother of three came to us with the complaint that she had a spontaneous abortion early morning. She was in her fifth month. The problem was that she was diagnosed couple of weeks back that she had a twin pregnancy. Only one baby had come out. According to her, the second baby has not yet been expelled. 

I wish I had taken her snap when she was wheeled in. Her abdomen looked as if it contained one term pregnancy. On palpation, it was quite funny. There was a good fluid thrill and the abdomen contour was quite uneven. 

On ultrasound, she had huge ascites and there was a solid mass inside the abdomen. We got the ascitic fluid drained out. It was obviously a malignancy. She gave a history of 5 months . . . and she had attributed the gradual onset of her abdominal swelling to the pregnancy. And the ultrasound done couple of weeks back gave her a report 

Then the problems started . . . We discussed about referral and further treatment. She was quite young. She had little children. The family was very very poor. 

The husband and her mother made it very clear that they are taking her home to die. Both of them came and met me today morning and told that if we could do anything to relieve her pain. 

We discussed on what could be done. We took help from Dr. Hilda, our gynecologist colleague in Chattarpur. Considering the huge swelling, I was sure that some amount of debulking of the tumour would do her a lot of good. Of course, there could be secondaries. An ultrasound and X-Ray showed that the lungs and liver were clear. 

After a long interview with the family we decided to go ahead with the surgery. 

It was a huge swelling . . . certainly the largest we had recently. The mass weighed 3.6 kilograms. Thankfully, the mass which originated from the ovary did not have much adhesions. The sad thing was that she had seedling in the peritoneal cavity. 

Kindly pray as she recovers. We've send the mass for histopathology . . .  We would also like to people contributing for her treatment. The total costs would be about 20,000 INR. 

Angel practising her skills of 'grossing'

The cross section of the swelling