SURGICAL PROBLEMS IN THE MONSOON

Dr Amit Thadhani MS, FMAS
Head, Department of Minimal Access Surgery, Niramaya Hospital
Maitri Park, Sion Trombay Road, Chembur, Mumbai-400071

The monsoon is the most eagerly awaited and beautiful time of the yesar following the summer heat. It is also a time for many health problems that can lead to surgery if not treated in time correctly. It is no surprise that “rush season” for doctors is the monsoon. Common illnesses in this season include Respiratory tract infections, Boils, Typhoid, Dengue fever, Malaria, Leptospirosis, Diarrhoeas, Trauma & injuries etc.

Respiratory tract infections may be as simple as common cold but can extend to pneumonias and subsequent lung abscesses that may require thoracoscopic treatment or even open surgery if neglected. Sinusitis may become chronic and eventually require surgical treatment. These can usually be prevented by taking due precautions.

Boils are common problems associated with high humidity and poor hygiene. Small boils (called “furuncles”) usually respond to treatment with antibiotics and analgesics. A larger boil called “carbuncle” if it involves the skin, or “abscess” if it involves the soft tissues may require to be drained under anaesthesia. Untreated boils can rupture and cause non-healing wounds, or get disseminated through blood to create a life-threatening condition called septicemia which requires prolonged treatment with high IV antibiotics.

Typhoid can cause several life-threatening surgical problems such as rupture or perforation of the intestine, infection in the gallbladder (cholecystitis), urinary infections, intra-abdominal abscesses, pneumonias, meningitis and other serious conditions, several of which can be fatal if not diagnosed in time. Patients suffering from typhoid should report to the doctor immediately if they develop severe abdominal pain, high fever, vomiting or dark coloured stools. In doubtful cases, a diagnostic laparoscopy may be indicated. However, if the patient is critically ill, conventional open surgery is life-saving.

Malaria, leptospirosis and dengue can cause severe depletion of platelets, resulting in internal bleeding in the abdomen, chest, brain and other organs. The blood may have to be removed by emergency surgery with placement of drains into the cavities apart from intensive medical management of the condition. Nowadays, many patients suffering from these diseases do not have fever and hence even if you have a severe bodyache and associated weakness, platelet depletion should be ruled out by a simple blood test if symptoms persist for more than a day.

One of the commonest conditions caused by contaminated water and foods is diarrhoea. The incidence of diarrhoea is highest in the monsoons as the chances of contamination are highest in this season. If not treated properly, diarrhoeas can become chronic and extend over several months, leading to a condition called Post Infectious Irritable Bowel Syndrome. Advanced investigations such as colonoscopy and metabolic workup may be required for ruling out more sinister conditions associated with chronic diarrhoeas.

Vehicular accidents are more common in the rains and the number of fatal injuries rises sharply in this season. Head injuries, chest and abdominal injuries, fractures etc require the appropriate surgical intervention. It is imperative that the person be transported to hospital within the “golden hour” which is within one hour of the trauma. The role of laparoscopy in a case of blunt abdominal trauma with suspected injury to vital organs is unparalleled and if the patient is stable enough, treatment of the injury can be carried out by laparoscopy. However, if the patient is bleeding heavily, conventional surgery is indicated.

In summary, the monsoon is a good time to take care of your health while enjoying your soak in the rains. Due precautions can prevent most problems associated with the rainy season and early care can prevent complications that may require surgical intervention.