Although none of the editors of Insidesurgery are participating in the care of Cuban leader Fidel Castro, we are following with interest the cryptic news releases coming out of the country. Undoubtedly vague and misleading on purpose, there are a few things we can comment and conjecture on, based on official reports from the Cuban government.
“I can say that it (Castro’s health) is stable, but a real evolution in my health takes time.”
This seems to indicate that his perioperative period was stable, but that the overall prognosis is in doubt, based on the condition necessitating the surgery, rather than the surgery itself. This would most likely point to a malignancy, where many patients have “successful surgery” but do not have surgical cures. Tumors that fit into this “intestinal category” are pancreatic adenocarcinoma, gastrointestinal stromal tumors, colon cancer, stomach cancer and hepatobiliary cancer. In addition, they may be hinting at the placement of a gastrostomy tube (a tube placed into the stomach that relieves bowel obstruction) for diffuse carcinomatosis.
“I can not make up good news because that would be unethical.”
Again, this seems to portend an ominous prognosis. It seems likely that any benign condition treated with successful surgery would be championed as such. Intestinal surgeries that fall into this benign category are for peptic ulcer disease, bowel obstructions from adhesions,hernias, or bezoars, rectal prolapse, liver resections for hemangiomas or infectious disease, and splenectomy.
If the Cuban authorities are using the term intestinal for intra-abdominal or retroperitoneal, then the possible surgeries include repair of aortic aneurysm and kidney surgery.
“Stress has forced (Castro) into surgery.”
There are a few surgical conditions that can be worsened by stress possibly, although the role of stress in exacerbating these conditions is debatable. They would be inflammatory bowel disease (Crohn’s or ulcerative colitis), peptic ulcer disease, and pheochromocytoma.
“(Castro) will be in bed for several weeks.”
Although Cuban medicine is generally not considered to be of the same quality as American medicine, it is considered advanced for a Third-World country. Cuban surgeons probably know that bed rest after surgery is now frowned upon. The current trend in post-operative care is to ambulate patients as soon as possible. In the biggest abdominal operations done on patients (liver transplants, pancreas resections, aneurysm repairs) every effort is made to get people out of bed in the first day or two. So, it is hard to imagine what surgery would keep Castro in bed for several weeks if he was not at a terminal stage of his life.
There is something suspicious going on here. If Castro had some non-life threatening condition, why would the authorities not simply say that he had a perforated peptic ulcer which was successfully repaired and that the recovery time would be a week?
My guess – Castro has widely metastatic colon or stomach cancer and will be dead in the next several weeks without ever regaining control of the country.
Copyright 2006 Insidesurgery.com