Page 21 - Volume 69 Number 2
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I was convinced that resecting more small bowel was not the answer. Twelve years earlier, when I was on a rotation in Haiti as a resident, I had learned to treat perforated typhoid ulcers by simply oversewing them. These perforations looked a lot like typhoid ulcers.
I took a deep breath and oversewed them. He went home a week later.
A few hours after my phone conversation with Walter from Las Vegas, I received a phone call from Barry Fisher, the surgeon on call at the University of Nevada Las Vegas medical center. As luck would have it, Barry remembered me from a surgical meeting we had both once attended, although I had no recollection of this. I told him to take Walter to the operating room, where he would find one or more jejunal perforations. “Trust me,” I said, “just oversew them.” “Walter will make a remark- ably swift recovery.” Dr. Fisher did just that, and Walter did make a swift recovery. He returned to Michigan a week later. It was a great story, with a happy ending.
I wish I could end the story here, but I can’t. Walter was destined to have four more operations over the next five years. A year later, with the usual prodromal symptoms and after a herald 14 unit GI bleed, he
required another short small bowel resection for a penetrating ulcer. Three years after that, a five cm ulcer in the ileum was resected. A few months later he developed an enterocutaneous fistula, not from the recent anastomosis but from a new, penetrating ulcer.
I resected this in May 1987. His last operation was in February 1988, for new small bowel ulcers. The most remarkable thing about Walter was that he always recovered rapidly. He never had a complication. He almost never looked sick. He went right back to work. He never developed an incisional hernia, despite nine operations in 12 years through the same incision.
On April 30, 1988, his son called to tell me that Walter had died at home, unexpectedly. I asked him to please get an autopsy, because we really wanted to know what his underlying disease process, which at various times had caused obstruction, perforation, enteroenteric and enterocutaneous fistulization, and life-threatening hemorrhage, was. The cause of death was an acute myocardial infarction resulting from an 800 mL bleed from a new jejunal ulcer. He never had a chance to call and say, “I think it’s happening again.”
Volume 69 • Number 2 Washtenaw County Medical Society BULLETIN 21

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