Merceline A., 21

Merceline is the first born in her family. Due to financial hardship, she dropped out of Form One and depends on her grandparents, who are peasant farmers. Her family learned about Helpster through a medical practitioner from a former partner hospital. Her grandmother reported that Merceline developed severe abdominal pain, abdominal swelling, vomiting, and inability to pass stool for two weeks. Three days before admission, she also had a spontaneous miscarriage at 14 weeks gestation with ongoing mild vaginal bleeding. As her condition worsened, she was first taken to a nearby facility before urgent referral to Siaya County Referral Hospital. She was diagnosed with small bowel volvulus and a left ovarian cyst adhered to the colon and omentum. She underwent emergency laparotomy with bowel resection and anastomosis. After surgery, she developed an anastomotic leak, surgical site infection, malabsorption, and severe anemia requiring prolonged admission, blood transfusions, total parenteral nutrition, infection management, and creation of a stoma to reduce risk of severe sepsis. She has been hospitalized for more than 1 month.

Merceline was admitted to Siaya County Referral Hospital after being diagnosed with intestinal obstruction secondary to volvulus, a life-threatening condition in which the intestine twists and can compromise its blood supply. She underwent an emergency exploratory laparotomy to identify and manage the obstruction. Her treatment was unfortunately complicated by a stoma leak, requiring another exploratory laparotomy, as well as malabsorption and a surgical site infection. Throughout her admission, she received several medications and supportive treatments, including intravenous antibiotics such as ceftriaxone and other prescribed medications, including Flagyl, penicillin, paracetamol, and tramadol, alongside other treatments required according to her changing clinical condition. Despite these challenges, Merceline gradually began to improve. Once her condition stabilized sufficiently, the medical team was able to take her back to theatre and successfully close the colostomy site. Eventually, Merceline’s condition improved enough for her to be discharged from the hospital on oral medication.

Merceline’s condition is serious but manageable with continued specialized medical care. Following her diagnosis of intestinal obstruction and stoma leak, she underwent an emergency exploratory laparotomy (ex lap) to control the leakage and prevent further contamination of the abdominal cavity. The development of malabsorption and a surgical site infection indicates that her recovery may be prolonged and will require close monitoring and supportive treatment. Currently, she is on total parenteral nutrition (TPN) to ensure that her body receives adequate nutrients while allowing the intestines and surgical wound time to heal. Regular wound dressing and infection management are important in preventing further complications and promoting tissue recovery before definitive wound closure surgery can be performed. If Merceline continues responding well to treatment, with improvement in nutritional status, healing of the surgical site, and control of infection, there is a fair chance of gradual recovery. However, because of the severity of her condition and the risk of complications such as recurrent infection, sepsis, poor wound healing, or prolonged malnutrition, her prognosis remains guarded and she will require ongoing surgical follow-up, nutritional support, and careful inpatient management.