Boy undergoes complex surgery to remove spear from thorax

by Lyf Compton

Despite harsh criticism levelled at the local health sector on a daily basis, medical personnel here continue to perform lifesaving procedures, most recently on a 14-year-old student of Barrouallie.

It is not everyday that one sees someone with a spear protruding from the chest, but that was what presented at the Accident and Emergency (A&E) Department of the Milton Cato Memorial Hospital (MCMH) on Tuesday, November 19 when Orthis Williams entered its doors.

This hunting spear (at right),went through the
right side of 14-year-old
Ortis Williams’ his back, penetrated his thorax with the tip stopping just short of exiting his chest. The spear also went through the spine/vertebral column, but missed the spinal cord.

Rushed to the MCMH by the police, Williams was severely injured during a hunting trip to the Peter’s Hope mountains.

The incident report says that one of Williams’s friends accidentally pierced him with a rusty metal spear. The hunting implement went through the right side of his back, penetrated his thorax with the tip stopping just short of exiting his chest. The spear also went through the spine/vertebral column, but missed the spinal cord.

“We were thinking, this is a difficult case, seems as if this would have gone through the spine and so on, he is going to be paralyzed and the oesophagus would have been damaged and we started thinking about all the possible complications that could come about,” Dr Jasmine Ellis-Davy, paediatric surgeon at the MCMH told SEARCHLIGHT this week.

She said initially, when they saw the patient, they began thinking about all the issues, but later realized that while

the situation was extremely serious, luckily, the spear did not damage the spinal cord.

Last Sunday, November 24, Williams underwent a four-hour surgery which was planned and executed by MCMH personnel.

Ellis-Davy, a medical practitioner for the last 12 years, did the surgical planning, while the procedure was executed by three general surgeons, an ear, nose and throat (ENT) surgeon, a gastroenterologist, along with the anaesthetic team which included two anaesthesiologists and two nurses.

“This was extremely difficult, tedious, complex. It took a lot of planning and it took a lot of consultation with the multidisciplinary team. This was teamwork, one person couldn’t have done it. It had to take everybody, all heads together and we planned,” said Dr Ellis Davy who has five years experience as a surgeon.

The Cuba-educated doctor said when the student came to the hospital with the spear jutting from his back, they cut the excess off, but they had to leave piece jutting out so they could manipulate the spear during the surgical intervention.

“So, we removed the excess and the patient was admitted to the ICU last week Tuesday night around 11:30 and was clinically stable and we obtained all the imaging studies so we could prepare for the case,” explained the doctor.

“I did the planning, but I couldn’t do the work myself,” she explained.

The other doctors involved were ENT surgeon Dr St Clair Thomas, gastroenterologist Dr Patriana Badenock, general surgeon Dr Barry Aussi; and two Cuban surgeons Dr Edwardo Alexis Manrique Gonzales and Dr Horlirio Ferrer. Anaesthesiologists Dr Arlene Miranda Hernandez and Dr Gleidys Escobar Ameijeiras and nurse anesthetist sister Yvonne Alexander and Geidys Montesinos. Staff nurses Shari Commissiong, Venisha Sutherland,Barbara Providence and Petra Bailey were also involved.

Ellis Davy said they have never done a procedure like this in St Vincent and the real lesson to be learnt is the importance of the multidisciplinary team working together and pooling resources.

“It was really good to see we could pool what we have and get things done for the patient. One of the messages to drive home is the importance of working together as a team for the benefit of the patient,” stressed Dr Ellis-Davy.

She said at this point, the patient is clinically stable, and he has no neurological deficit.

“…Meaning he is not paralysed or anything which was one of the fears we had initially. He is moving all limbs thus far. He does have a perforated oesophagus, intra thoracic in the chest, which we are managing. The recovery process is day to day, and he is still in the ICU,” the paediatric surgeon said.

Explaining a bit about the complexity of the procedure, the surgeon said the spear had two pieces of metal at its tip called barbs which are designed to make it hard to remove once it hits its mark.

“The barb of the spear went in and that was stuck inside the chest. We were seeing it on the image,” said Ellis-Davy who revealed that they had to push the spear through the front of the chest to get it out, as removing it the way it went in would have been wrong.

“We had to advance it out to the front because it was stuck in the muscles and these muscles were gripping really really tight and we had to wiggle it and pull it out from the front.

“It is really commendable what we were able to achieve, as it was the first chest surgery of this kind,” said the doctor who added that they have removed foreign objects like knives from persons, but thoracic surgeries are extremely rare.

“We are a third world country and with the resources that we have, I think we do a lot and most of the times people would report the bad things, but we do a lot of good things and have good outcomes from our surgical interventions which you really don’t hear about,” said Ellis-Davy.

Earlier this year, another lifesaving surgical procedure was carried out on Byera resident Michael “Mike” Woods.

Woods, 56, and a farmer, received a vicious chop wound that damaged his intestines and left them hanging out of his body. The surgery that saved his life was done by Cuban surgeon Dr Horlirio Ferrer-Robaina at the Modern Medical and Diagnostic Centre (MMDC) in Georgetown.

“This was more difficult than the surgery in Georgetown, we don’t do thoracic surgeries every day and thoracoscopy every day,” said Ellis-Davy.