The Sterile Eye

A while ago I wrote a post about the smell of smoke from electrosurgery, wherein I said:

Opening the abdominal cavity does not emit any smells, unless there’s some infected parts, necrotic tissue, pierced bowels or gas present.

This week I filmed an operation where the bowels, or actually the stomach, was pierced on purpose.

This was an operation to remove a large gastrointestinal stromal tumor (GIST) of the stomach. GISTs are quite rare connective tissue tumors of the GI tract, and classified as a form of sarcoma. The large tumor (⌀≈20 cm) started in the right stomach wall and protruded laterally, adhering to the spleen and the tail of the pancreas.

To remove the tumor the spleen was first dissected and mobilized. Then the stomach was divided medial to the tumor, with good margins. The picture at the top shows a suction tube in the open stomach. You can see the rugal folds of the mucosa.

At this point the inner scents manifested themselves. I think I’ve never smelled a more dense and heavy smell before, spreading all over the OR very fast. Unsurprisingly it smelled like vomit. More than anything else it made me think of the sheer amount of chemical reactions going on in our GI tract. Takes a powerful process to produce smells like this. Sitting a few meters from the operation table, breathing only through my mouth, I didn’t even want to think about how it must be for those in the sterile field. They’re more used to it of course, but still - a very penetrating odour.

Finally, a small part of the tail of the pancreas was cut of, and the surgical specimen was removed. The stomach was sutured and the abdomen closed.

Surgical specimen of a gastrointestinal stromal tumor (GIST) of the stomach. The spleen is adherent to the tumor on the right.