Hernia is an abnormal anatomy caused by an organ or tissue leaving its normal anatomical position in the human body and entering another part through a congenital or acquired weak point, defect or hole.
Diaphragmatic hernia is a type of internal hernia, which refers to a disease state in which organs and other organs in the abdominal cavity move ectopically into the chest cavity through the diaphragm. It can be divided into traumatic diaphragmatic hernia and non-traumatic diaphragmatic hernia.
The most common non-traumatic diaphragmatic hernias are hiatal hernia, thoracoabdominal hiatal hernia, parasternal hernia and absent diaphragm. Hiatal hernia is the most common hernia among diaphragmatic hernias, accounting for more than % of all cases.
Normally, hiatal hernia occurs when the stomach and intestines appear in the chest through the weak diaphragm.
The most serious complication is incarceration of the hernia sac, in which strangulated necrosis occurs in the abdominal organs herniated into the chest cavity.
In this case, emergency surgery is usually required. If the meal does not last long and the gastrointestinal tract can restore blood supply, that is the best.
Otherwise, a series of resections must be performed to avoid complications such as more severe necrosis and infection and toxic shock.
This will kill you.
However, diaphragmatic hernia usually occurs when hollow organs such as the stomach and intestines herniate into the chest cavity. For example, the liver, such a large solid organ, rarely herniates.
This kind of surgery can be performed by general surgery or thoracic surgery.
So when they heard about liver hernia, both Zheng Ren and Su Yun became interested. It was so rare that they wanted to take a look.
The bullshit consultation fee of 100,000 US dollars was forgotten by the two of them in an instant.
I quickly came to the emergency department. In the emergency room, there was a room full of family members of the patients, and two medical staff from out-of-town private 120 hospitals were collecting fees.
Seeing that Zhou Litao was busy doing a physical examination, Zheng Ren did not call him, but began to observe the patient.
The background in the patient system panel is bright red, which means the condition is serious.
Seventy-eight diagnoses such as asymptomatic congenital retrosternal diaphragmatic hernia, diaphragmatic hernia repair, liver hernia, septic pneumonia, pericardial effusion, etc. appeared in front of Zheng Ren.
Retrosternal diaphragmatic hernia, Zheng Ren seemed to have guessed something.
The abdominal organs protrude into the thoracic and cardiophrenic angle area through the thoracic and costal triangle, which is called congenital retrosternal diaphragmatic hernia, also known as retrosternal hernia, parasternal hernia, anterolateral hernia or mangri hiatal hernia.
This type of hernia is relatively rare, accounting for 3% to 5% of diaphragmatic hernias. There are multiple attacks on the right side of the chest, with respiratory and digestive system symptoms being the main symptoms.
However, the organs herniated into the chest are mainly the gastrointestinal tract, and the liver is relatively rare.
Liver hernia... Liver hernia... Zheng Ren thought intently.
Su Yunze had already been close to the patient to watch Zhou Litao's physical examination.
The nurse in the emergency department was busy when she felt someone crowding in. She raised her eyebrows and turned around impatiently to push the person away.
But the moment she saw Su Yun, her face turned red and she didn't know where to put her hands. I don’t dare to look at it, I don’t dare to look at it but I still want to look at it, I’m so confused.
"What patient?" Su Yun asked gently.
"The post-operative patient sent from a nearby city hospital had two surgeries, and now he has a space occupying the right side of his chest." The nurse didn't know much, but she could tell as much as she knew, and she sincerely had no reservations at all.
After saying that, she felt a little ashamed.
I know very little, this is so wrong, eh eh eh ~
"Su Yun, you're here." Zhou Litao heard someone talking next to him. After checking his body, he turned around and saw that it was Su Yun.
"Call Brother Yun." Su Yun squatted on the ground, looked at the breast bottle, and whispered.
"Brother Yun, the closed chest drainage has led to a small amount of air. It is estimated that the lungs are still damaged." The nurse added.
Why is it so hot in April? She felt her face was so hot that she couldn't even wear the mask. The hot air sprayed up from the gaps in the mask with the breath, raising the temperature of the entire face a lot.
It's all this damn weather, the little nurse thought to herself.
"Mr. Cui is in the office." Zhou Litao held a notebook with a stack of A4 paper in his hand, recording the conditions of many patients in his own way.
When Su Yun asked him to call him Brother Yun, Zhou Litao seemed not to hear. Every freckle on his dark face expressed rejection.
He said a few words to the family members, arranged for an emergency department doctor to deal with it, and then came to Mr. Cui's office with Zheng Ren and Su Yun.
Knocking on the door and going in, Zhou Litao began to report the medical history.
Mr. Cui didn't say anything to Zheng Ren. He just glanced at him and began to listen to Zhou Litao's report seriously.
"The patient is a 55-year-old female who was diagnosed with congenital retrosternal diaphragmatic hernia by the local hospital.
The patient developed progressive dyspnea and palpitations during activity 8 months ago, which worsened for 2 months. He was admitted to a local hospital and underwent surgery.
Preoperative report: The intestinal contents in the chest compressed the middle and lower lobes of the right lung, causing atelectasis and mediastinal deviation.
Here is a picture of the patient before his first surgery. "
With that said, Zhou Litao skillfully took out a bag from the film bag and handed it to Mr. Cui.
Judging from the details, Zhou Litao is indeed a very capable emergency department resident. After only a short period of understanding the condition and physical examination, many situations can be basically understood. When reporting to Mr. Cui, he was also very orderly.
Zheng Ren praised it in his heart.
"Continue." Mr. Cui said lightly without watching the movie.
"In the first operation, it was found during the operation that the median diameter of the retrosternal defect in the mediastinum was 7 cm, and most of the herniated parts included the small intestine, large intestine, and the greater omentum. It was discovered when the right lung was re-expanded after resection of the hernia sac. Emphysema bullae and spontaneous pneumothorax. The chest department consulted on the emergency table and provided closed chest drainage."
Zhou Litao took the case copy copied by the patient's family, quickly turned to the page of the surgical record, and highlighted the key points.
"Six hours after the operation, a large amount of air was discharged from the closed chest drainage. The amount of air was very large. After consultation with the thoracic surgery department, it was decided to perform a second thoracotomy to repair the bullae."
"One week after the operation, the patient suffered a sudden ventilatory disorder, and an urgent liver function test revealed elevated transaminases. CT showed that the right lung was compressed again, and a solid organ entered the chest cavity, which was suspected to be the liver."
"The local doctor communicated with the patient's family and recommended that the patient come to our hospital for treatment."
After saying that, Zhou Litao put down the medical record folder and inserted the latest chest CT film into the reader.
Zheng Ren unconsciously put his left hand under his right armpit, supported his chin with his right hand, narrowed his eyes slightly, and began to read the film.
Zhou Litao described the patient's condition in great detail. Two surgeries, one thoracic surgery and one general surgery.
Not only did the patient's condition not improve after surgery, but he developed a more serious liver hernia.
Emergency surgery is required, that's for sure. But whether it is a thoracic surgery or a general surgery surgery, the sense of proportion is very subtle.
Most doctors are not willing to take over post-operative patients sent from lower-level hospitals.
That means big trouble.