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BMJ. 2007 June 23; 334(7607): 1321.
PMCID: PMC1895671
A Memorable Patient

Appendicitis in the Himalayas

Ram Hari Ghimire, student, Institute of Medicine, Kathmandu, Nepal

In October 2006 a British echocardiographer, a senior house officer from Kathmandu, and myself were in Lobuje (4900 m above sea level), eight hours' walk below the Everest base camp in the foothills of the Himalayas. We were there to help with the “high altitude pulmonary edema prevention trial 2006.”

One evening, when it was snowing outside and the dining hall of the teahouse was full of the trekkers on their way to or from Everest base camp and Kalapathar, we were busy tabulating our research data. The owner of the teahouse approached us and said that one of the girls working for the teahouse had been complaining of severe abdominal pain for the past few hours. We hurried to her room and found a 15 year girl rolling from side to side in pain on her bed. When we had finished taking her history and examining her we had the impression that she could have acute appendicitis. We were worried that the nearest town with surgical facilities was Kathmandu, an eight day walk down the hills or a 45 minute flight from Lobuje—the latter being almost impossible for a poor maid girl without an inkling of insurance.

We had been using an echocardiography machine for our research, so we considered the possibility of getting an abdominal scan of the girl. However, doing an abdominal scan was as challenging for our echocardiographer colleague as it was for us. We therefore made an announcement in the dining hall, asking if there was anyone who could do it. To our surprise, there were two British radiologists on their way to Everest base camp. They did the abdominal scan with the probe normally used for echocardiography and found no evidence of acute appendicitis, ruptured ectopic pregnancy, or peritonitis. We therefore decided to treat the girl symptomatically and gave her painkillers and antibiotics. With the drugs, her pain subsided to a great extent, and she slept the night. Early the next morning she left for Kathmandu.

Twelve days later, when I was on my way back to Kathmandu, I met the girl returning to Lobuje. She told me that she had walked for four days down the hills with a friend and then took a flight from Lukla to Kathmandu. There, she was found to have an appendicular lump and was admitted and given some medications. She was also advised to have an elective appendicectomy after six weeks.

I explained the possible immediate complications of an acute appendicitis that she might have developed, and we agreed that it was her luck that she had avoided them. Otherwise, what would have happened to that poor girl from the Himalayas without basic healthcare facilities?


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