Gavin’s mystery illness—diagnosed!
An exploratory abdominal operation revealed that a loop of the bowel was trapped by an adhesion, a band of scar tissue that binds two other tissues together that are not normally attached. Ninety per cent of these occur after abdominal surgery, says Dr. Stuart Whitelaw, but they can also be the result of an injury. “It’s likely in this case that the patient suffered a long-forgotten blow to his abdomen in childhood (perhaps falling from a tree or receiving a punch on the playground) that led to the development of an adhesion.”
Had the cow not fallen on Gavin, the abdominal adhesion may never have caused a problem, Whitelaw says. “But the cow compressed his abdomen and, bizarrely, forced the intestine through a gap caused by the adhesion.” It was a life-threatening problem. The small bowel would become strangulated, blood flow would stop and the integrity of the lining of the bowel would be compromised. This could allow bacteria into the bloodstream, leading to septic shock and multiple organ failure. That same result could occur if a perforated bowel allows bacteria to leak into the nearby abdominal cavity.
Whitelaw performed an emergency operation to divide the adhesion and relieve the obstruction, but while he was inspecting Gavin’s other organs, he noticed a small tumour on the patient’s cecum (a pouch at the beginning of the large bowel). The doctor removed the tumour by cutting out the right side of the large bowel. He then joined the ends together and sent the specimen to the lab. Gavin, meanwhile, made a quick recovery and within days was back on his farm, attending to the new calf and its mother.