Guts?

Before starting practice I thought I had a pretty good idea of the types of things I would be seeing and the calls that I would get from clients. Of course I was wrong in that assumption and now it is to the point that when someone calls and tells me something, I believe almost anything they say is possible. Earlier this spring I got back from a day in the country to find an interesting case waiting for me. The owner said that he had a newborn calf that the guts had come out of the navel when it was born. I have seen this occasionally and asked how long it had been out and how clean they were. He said, "Oh, the guts aren't actually out there is a big ball of skin around them". Of course now I was curious and thinking that we had just a regular hernia. As always you don't know until you look so out we went to peek in the back of his pickup to see what we had.

Mildly confused is how I started out as he was right there was a sack full of something hanging out of the calf's navel. It was a thin sack with no hair on it that looked mostly just like connective tissue and the contents were about the size a women's basketball. Once I started to feel it my confusion moved up to a moderate level. Part of the contents were very soft and squishy, and part was very firm; almost like muscle. The hole in the navel was very small and I was unable to return any of the contents back into the abdomen. Because the sack was not clear I couldn't see the contents and decided to cut it open for a better look. At this point I was expecting that the "squishy" part was normal small intestine and the "firm" part was small intestine the was twisted or strangulated and was very full and tight. Not to my surprise; I was wrong. To my surprise; when I cut the sack open, I found some small intestine and a large section of liver. No one has to go to years and years of school to know that no part of the liver should be hanging in a sack outside of the belly. You also don't have to go to school to know that a volleyball sized piece of liver did not go through a hole as big as two of my fingers. That the leaves the option that the liver (or at least a section of it) was actually formed on the outside of the body.

Now that we had established what we were dealing with the discussion went something like this:

So the liver is outside of the body?

Yes.

Can you put it back in?

Yes

Does it have a chance?

(This is where my philosophy is that honesty is the best policy)

I have absolutely no idea.
Since we know that this part of the liver was formed outside of the body I don't know anything about he connections to the blood supply, whether the liver will function properly, what other malformations there may be, or really anything to indicate whether this calf could live.

Wow, that's really interesting. So what would it cost to operate on it? Well, what the heck, I am curious to give it a try and see if it will live.

So we proceeded to do a liver-returning-into-abdomen surgery in the back of his pickup and sent him on his way.
That was two months ago.

The other night I was out to their farm to fix a broken leg on a calf and son number one says "Well your miracle calf is still alive, in fact you can't even pick it out from the rest of the calves unless you know which tag number it is!"

Now when people ask me is there a chance I think I will repeat what I heard somewhere:

"Where there is a heartbeat there is hope."