The importance of pre‐operative examination, don't let them pull the wool over your eyes!

We wish to report an unusual case, which was cancelled following the pre-operative anaesthetic assessment. A 17-year-old girl was due to have a small thyroglossal cyst removed on an elective ENT list. She had been seen by a nurse and a surgical SHO in the pre-admission clinic and was admitted on the day of surgery. She was assessed on the ward pre-operatively by a consultant anaesthetist. The patient was known to have an ejection systolic murmur secondary to a bicuspid aortic valve. She appeared fit and was not suffering from any cardiac disability. In order to examine her chest, it was necessary for the patient to remove her bulky fleece jumper. It was immediately apparent that the patient had a large abdominal mass consistent with a third trimester pregnancy. When asked about her last menstrual period, the girl replied that she did not have periods. The subject was then broached as to whether she could be pregnant. This was flatly denied. She did, however, agree to have a urine pregnancy test (beta HCG), which was positive. The result was discussed with the patient and she immediately said she did not wish to continue with the pregnancy. She was referred to a Consultant Obstetrician in the antenatal clinic. He saw her immediately and arranged an abdominal ultrasound scan for the following morning. The girl told her mother the surprise diagnosis and was discharged home that evening. You can imagine our shock to learn that the patient gave birth to a baby daughter on the sofa at home later that evening. Mother and baby are both doing well! The importance of the pre-operative examination in all patients, as well as asking patients to remove bulky clothing when examining them should never be underestimated. You never know what you might find!