12 years... ?

A woman came in today for a prenatal. She is 4 months into her 7th pregnancy and is almost (if not well into) her forties. The Sudanese sun hasn’t been kind.

She has a disarmingly sweet smile but it’s not the first thing you notice about her. 

When I was checking her in, I noticed a large growth on her side. It was well hidden by her wrap, so I couldn’t tell what it was exactly. But one thing I knew for sure, it was big.

Due to her age, I thought she’d be menopausal with some kind of abdominal growth. I was wrong -- twice.

Her growth was actually her right breast. It was roughly the size of a small cantaloupe melon with a 40 cm diameter. When I asked her how long she’d had it, she explained that it’d been that way for 12 years.

Apparently, after one of her babies her breast got very engorged. It increased to the size it is today within a few days. And at the time it was very painful. Ever since, she has been unable to breastfeed from it and after each pregnancy, it leaks “pus”.

When she walks it dangles mid-thigh and only hurts her chest due to its weight. She explained that she sometimes wraps it up over her left shoulder but it just gets too hot. She prefers to let it dangle to her side.

It’s symmetrical and non-fluctuant, even a bit fibrous. I’ve never seen anything like it outside of obscure medical books.

I asked her if she has ever seen a doctor about it. She explained that three years ago she went to Wau for a check-up but they said they (too) had never seen anything like it and couldn’t do anything for her.

I encouraged her to go back and get another opinion. I know of doctors (in the Philippines) doing full mastectomies in the jungle, why couldn’t they do something about her right breast in Sudan?

Engorged...

On Friday, one of my prenatal patients came in a few days postpartum with a seriously engorged left breast. It was 2 and 1/2 times it’s normal size and shiny with stretching. It looked outrageously painful.

We helped express a lot of the milk and even got the baby to nurse from it. Well, I’m not sure what happened over the weekend... but she came in today with open erosions on her skin. Engorgement has progressed to Abscess ridiculously fast.

Or had it? It is guessed that her family in an effort to help with the engorgement continued to express the milk very aggressively. They made things worse. Now she has three large erosions on her breast. It is still just as engorged. I can barely imagine the pain she must be in.

Thinking that it had become an abscess, Dennis incised it today. No pus was removed but a drain was placed in and we’ll be caring for her daily until it improves. I honestly don’t know what to think.... other than ouch!

I’ll keep you posted.