Auto-appendectomy: Antarctica Survival Guide

April 19, 2010 in Medicine by RangelMD

What happens when Murphy’s law strikes and the surgeon comes down with acute appendicitis without anyone else available to perform an appendectomy? This is what happened (BMJ via Kludges) to Russian surgeon Leonid Rogozov in April 1961 while stationed at the Soviet Antarctic base of Novolazarevskaya. Rogozov was the only medical professional at the new base and the antartic winter had just set in thus making any travel or hope of timely rescue literally impossible.

After several weeks Rogozov fell ill. He noticed symptoms of weakness, malaise, nausea, and, later, pain in the upper part of his abdomen, which shifted to the right lower quadrant. His body temperature rose to 37.5°C.

He took antibiotics but his condition was worsening. Facing a high likelihood of death from infection, the only solution was the obvious one. He was going to have to take out his own appendix.

Following Rogozov’s instructions, the team members assembled an improvised operating theatre. They moved everything out of Rogozov’s room, leaving only his bed, two tables, and a table lamp. The aerologists Fedor Kabot and Robert Pyzhov flooded the room thoroughly with ultraviolet lighting and sterilised the bed linen and instruments.

When the preparations were complete Rogozov scrubbed and positioned himself. He chose a semi-reclining position, with his right hip slightly elevated and the lower half of the body elevated at an angle of 30°. Then he disinfected and dressed the operating area. He anticipated needing to use his sense of touch to guide him and thus decided to work without gloves.

The operation began at 2 am local time. Rogozov first infiltrated the layers of abdominal wall with 20 ml of 0.5% procaine, using several injections. After 15 minutes he made a 10-12 cm incision. The visibility in the depth of the wound was not ideal; sometimes he had to raise his head to obtain a better view or to use the mirror, but for the most part he worked by feel. After 30-40 minutes Rogozov started to take short breaks because of general weakness and vertigo. Finally he removed the severely affected appendix. He applied antibiotics in the peritoneal cavity and closed the wound. The operation itself lasted an hour and 45 minutes.

Dr. Rogozov made a complete recovery (which is more than you can say about the Soviet Union) and was able to travel back to Russia in May of 1962.

Granted, as far as operations go, an open appendectomy is neither large or complex but to do one on yourself is the equivalent of Democrats fixing the health care system. Although the important lesson learned there is if you are going to a very remote place where you are going to be cut off from most medical care for more than a few weeks, it’s best to have your gall bladder and appendix taken out ahead of time.

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