Surgical practice in rural communities: challenges and opportunities.

I have attempted to point out some problems that face the surgeon in a rural practice as well as some of the advantages of living in a rural community. Surgical residents may find that a career choice in rural surgery merits their attention and consideration because the apparent obstacles can be readily overcome, and practice in a rural area can be intellectually and professionally challenging and rewarding.

Operative management of rural trauma over a 10-year period.

Trauma victims should in most cases be transported to the nearest trauma center as soon as possible after injury. Since this is not always feasible in underserved rural areas, the community hospital occasionally must function as the trauma center. From 1977 to 1987, while working in a rural community hospital in the northern Rocky Mountains, we operated on 83 patients with visceral and vascular injuries. The typical patient was a young man who sustained multiple injuries from motor vehicle or recreational accidents. Twenty-one patients had 27 major complications, and 2 died. Many small communities cannot afford helicopter-based trauma systems. Conversely, however, distance and geographic barriers limit access to designated centers. Accordingly, rural surgeons cannot opt out of trauma care and must look to trauma surgeons to help in solving access problems.

Acute torsion of the gallbladder.

Torsion of the gallbladder is an uncommon process that is usually found at the time of exploration for an acute surgical abdomen. It results from two congenital anomalies and may be complete or partial. It should be considered in the etiology of what appears to be acute cholecystitis in the elderly, thereby prompting early surgical management. Two cases are presented to help define the true incidence of this process.