The Neurosurgical emergencies that I witnessed during my surgical training were those that were at the Trauma Centre in the main hospital in Colombo called The Accident Service.
During my period of service at the Base Hospital in Polonnaruwa there were many occasions where I had to attend to patients with Neurosurgical Trauma, especially victims of war. I had to perform emergency surgery on the head as the nearest Neurosurgical Centre was at least 150 Km away in Kandy or the Centre in Colombo 240 Km away. That journey in an ambulance without trained paramedics could have taken 7-8 hours with disastrous consequences.
Under such circumstances, I had to carry out the necessary procedures in some patients who were not fit to be transferred to another hospital many miles away. I made use of the basic principles of surgery in such circumstances and these paid rich dividends in terms of saving lives. The description below is of a patient who survived a serious gunshot injury through his head. During the conflict, young boys in the bordering villages were trained in the use of shotguns. Thereafter they were provided with a shotgun and posted to guard their villages to prevent infiltration by terrorists. They were called Home Guards.
Indrajith was one such Home Guard. He had a nasty accident when he accidentally fired his gun during an argument with his colleague. When it fired, the gun barrel was close to his face. The bullet traversed from the region of the chin across the face, went through the left eye damaging it completely and exited through the left side of the skull after damaging the brain as well. On admission to hospital he was unconscious with brain matter and pieces of skull bone on his head. The wound on the face was bleeding. He had a serious injury to face, eye and brain and skull that required specialised care, but when such care cannot be given, I had to do what was necessary hoping for the best.
In the operating theatre, I made a semicircular incision on the scalp close to the injury to get adequate exposure of the wound and the extent of the underlying damage. Then I removed all fragments of skull bone. Through the defect in the skull the brain matter that was damaged was also removed with saline irrigation. The wound was closed after cleaning. Next, the damaged left eye was removed followed by the stitching the wound on the face.
There was no Intensive Care Unit to manage the patient postoperatively. He was managed in the general ward by my staff under close supervision. With appropriate medicine and antibiotics, he improved slowly and regained consciousness on the third day. There was no doubt that he was on the way to recovery and we gave him close attention. His wounds healed, although there was swelling in and around the eye. He was in the ward for over a month and then sent home to be followed up in the clinic. Gradually the eye-swelling too disappeared and in 2 months he was well orientated with good memory and ready to go back to guard his village although having only one eye. That was a happy day Indrajith his family and the entire staff of the Base Hospital, Polonnaruwa!
Dear Reader, you might be interested to read one the story of Susantha A boy from the rural hamlet, who was ‘Shot by the Terrorists’ and at present works in a hospital, one of the most appreciated, read and commented stories from my blog : ‘SUSANTHA – BOY FROM THE RURAL HAMLET’
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