Chapter 958 Two Surgeries (Leader ROMATOTTI Plus 3)

A hernia is an abnormal anatomy in which a certain organ or tissue in the human body leaves its normal anatomical position and enters 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 abdominal organs and the like move into the thoracic cavity through ectopic diaphragm, and can be divided into traumatic diaphragmatic hernia and non-traumatic diaphragmatic hernia.

The most common non-traumatic diaphragmatic hernias are esophageal hiatal hernia, thoracoabdominal hiatal hernia, parasternal hernia, and absence of diaphragm. Hiatal hernia is the most common type of diaphragmatic hernia, accounting for more than 90%, and is the most common type of hernia.

Typically, a hiatal hernia has the stomach and intestines emerge in the chest cavity through a portion of the weakened diaphragm.

The most serious complication is incarceration of the hernia sac, and strangulated necrosis of the abdominal viscera herniated into the thoracic cavity.

In this case, emergency surgery is usually required. It would be best if the gastro-intestinal tract can recover blood supply after a short period of time.

Otherwise, a series of excisions should be made to avoid complications such as more serious necrosis and infectious shock.

This is going to kill.

However, diaphragmatic hernias are usually hollow organs such as the stomach and intestines that herniate into the chest cavity. For such a large solid organ like the liver, hernias rarely occur.

This kind of operation can be performed in general surgery or thoracic surgery.

So upon hearing about liver hernia, both Zheng Ren and Su Yun became interested, it's too rare to see it, so let's take a look.

The nonsense $100,000 consultation fee was instantly forgotten by the two of them.

Quickly came to the emergency department, in the emergency room, a room full of family members of patients, and two medical staff from non-local private 120 were collecting fees.

Seeing that Zhou Litao was busy with the physical examination, Zheng Ren didn't call him, but began to observe the patient.

The background in the patient system panel is bright red, which means the patient is seriously ill.

Seven or eight diagnoses of asymptomatic congenital retrosternal diaphragmatic hernia, diaphragmatic hernia repair, hepatic hernia, hypostatic pneumonia, and pericardial effusion appeared before Zheng Ren's eyes.

Retrosternal diaphragmatic hernia, Zheng Ren seemed to have guessed something.

Abdominal viscera protruding into the thoracic cardiophrenic angle through the sternocostal triangle is called congenital retrosternal diaphragmatic hernia, also known as retrosternal hernia, parasternal hernia, anterolateral hernia or Morgangri hiatal hernia.

This type of hernia is relatively rare, accounting for 3% to 5% of diaphragmatic hernias. The right side of the thoracic cavity was multiple, with respiratory and digestive system symptoms as the main symptoms.

However, the organs herniated into the thoracic cavity are mainly the gastrointestinal tract, and the liver is relatively rare.

Liver hernia... liver hernia... Zheng Ren was thinking intently.

Su Yun had already gone to the patient's side to watch Zhou Litao's physical examination.

The little nurse in the emergency department was busy, when she felt someone squeezed up, she raised her brows, and turned her head impatiently to drive him away.

But the moment she saw Su Yun, her face turned red, and she didn't know where to put her hands. I dare not look at it, I want to look at it even if I dare not look at it, I am so entangled.

"What patient?" Su Yun asked gently.

"The postoperative patient sent by the nearby city hospital had undergone two operations, and now there is a space occupying the right side of the chest." The little nurse didn't know much, but she knew as much as she knew, and she didn't have any reservations from her heart.

After speaking, she felt a little ashamed.

I don’t know much about myself, it’s too wrong, huh huh~

"Su Yun, you're here." Zhou Litao heard someone talking beside him, and after checking his body, he turned around and saw that it was Su Yun.

"My name is Brother Yun." Su Yun squatted on the ground, looked at the chest bottle, and whispered in his mouth.

"Brother Yun, a small amount of gas has been drawn out from the closed chest drainage, and it is estimated that the lungs are still damaged." The little nurse added.

Why is it so hot in April? She felt that she couldn't even wear the hot mask. With the breath, the hot air sprayed up from the gap in the mask, raising the temperature of the whole 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 papers in his hand, and recorded the conditions of many patients in his own way.

When Su Yun asked him to call him Brother Yun, Zhou Litao acted as if he didn't hear it, and every freckle on his dark face expressed his rejection.

He talked to his family members for a few words, arranged for a doctor from the emergency department to deal with him, and then went to Elder Cui's office with Zheng Ren and Su Yun.

Knocking on the door and entering, Zhou Litao began to report his medical history.

Elder 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 female, 55 years old, and the local hospital diagnosed congenital retrosternal diaphragmatic hernia.

The patient developed progressive dyspnea and palpitations on exertion 8 months ago, which aggravated for 2 months. He was hospitalized in a local hospital and underwent surgical treatment.

Preoperative CT report: Intestinal contents in the chest cavity oppressed the middle and lower lobe of the right lung, resulting in atelectasis and mediastinal deviation.

Here is the film of the patient before the first surgery. "

As he said that, Zhou Litao skillfully took out a bag from the film bag and handed it to Mr. Cui.

Looking at the details, Zhou Litao is indeed a capable emergency department inpatient. It's just a short period of understanding of the condition and physical examination, and many situations are basically mastered. When reporting to Cui Lao, he was also methodical.

Zheng Ren praised in his heart.

"Continue." Cui Lao didn't watch the film, but said lightly.

"In the first operation, it was found that the median diameter of the mediastinal retrosternal defect was 7 cm, most of which were herniated into the small intestine, large intestine, and omentum. After resection of the hernia sac, it was discovered when the right lung was recruited Emphysema bullae and spontaneous pneumothorax. Chest consultation on the emergency table, and closed thoracic drainage."

Zhou Litao took the medical records copied by the patient's family members, quickly turned to the page of operation records, and picked the key points.

"Six hours after the operation, closed thoracic drainage led out a large amount of gas. The amount of gas was very large. After consultation with the Thoracic Surgery Department, it was decided to go to the stage for a second thoracotomy for bullae repair."

"One week after the operation, the patient had a sudden ventilatory disorder. An urgent examination of the liver function found elevated transaminases. CT showed that the right lung was compressed again, and a substantial organ entered the chest cavity. The liver was suspected."

"The local doctor communicated with the patient's family and suggested that the patient come to our hospital for treatment."

After finishing speaking, Zhou Litao put down the folder of the medical record, and inserted the latest chest CT film into the film reader.

Zheng Ren unconsciously put his left hand under his right armpit, rested 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 chest surgery and one general surgery.

After the operation, the patient's condition was not relieved, but more serious liver hernia appeared.

Need emergency surgery, that's for sure. But whether it is chest surgery or general surgery, the sense of proportion in the middle is very subtle.

Ordinary doctors are unwilling to take over postoperative patients sent by lower-level hospitals.

That means big trouble.