Hernia is an abnormal anatomical condition in which a certain organ or tissue in the human body leaves its normal anatomical position and enters another part through congenital or acquired weaknesses, defects, or pores.
Diaphragmatic hernia was a type of internal hernia. It was a disease state in which organs moved into the thoracic cavity through the diaphragm during abdominal time. It could be divided into traumatic diaphragmatic hernia and non-traumatic diaphragmatic hernia.
The most common non-traumatic diaphragmatic hernia are esophageal hiatus hernia, thoracoabdominal hiatus hernia, parasternal hernia and diaphragmatic absence hernia. Esophageal hiatal hernia is the most common type of diaphragmatic hernia.
It was the most common type of hernia.
Under normal circumstances, esophageal hiatal hernias would have the stomach and intestines appear in the chest through the weak diaphragm.
The most serious complication is hernia sac incarceration, herniated abdominal organs into the thoracic cavity appear strangulated necrosis.
This kind of situation usually required emergency surgery. If the meal is not long and the gastrointestinal tract can still restore blood flow, that is the best.
Otherwise, a series of resections would have to be done to avoid more serious complications such as necrosis and septic shock.
It would be fatal.
However, diaphragmatic hernia generally herniated the empty organs such as the stomach and intestines into the chest. For example, the liver was a large and substantial organ, and hernias were rare.
This kind of surgery could be performed by the general surgery department or the thoracic surgery department.
Therefore, when they heard about liver hernias, both Zheng Ren and Su Yun were interested. It was too rare. They wanted to take a look.
What bullsh * t 100,000 USD consultation fee? Both of them instantly forgot about it.
He quickly arrived at the emergency department. In the resuscitation room, the room was full of patients' family members. There were also two medical staff from a private first-aid company who were collecting fees.
Seeing that Zhou Litao was busy with a physical examination, Zheng Ren did not call him. Instead, he began to observe the patient.
The background of the patient's System panel was bright red, which meant that the patient's condition was serious.
Seven or eight diagnoses such as asymptomatic congenital retrosternal diaphragmatic hernia, diaphragmatic hernia repair, hepatic hernia, hypostatic pneumonia, pericardial effusion, and so on appeared in front of Zheng Ren.
A retrosternal diaphragmatic hernia. Zheng Ren seemed to have guessed something.
The abdominal organs protruding into the thoracic diaphragmatic angle through the thoracic rib triangle is called congenital retrosternal diaphragmatic hernia, also known as retrosternal hernia, parasternal hernia, anterolateral hernia, or Morgangri hiatal hernia.
This type of hernia was relatively rare, accounting for 3% to 5% of diaphragmatic hernias. The right side of the thoracic cavity was more common, mainly with respiratory and digestive system symptoms.
However, the organs that herniated into the thoracic cavity were mainly the gastrointestinal tract, and the liver was relatively rare.
'Hepatic hernia … Hepatic hernia …' Zheng Ren thought with rapt attention.
Su Yun had already moved to the patient's side to watch Zhou Litao perform a physical examination.
The young nurse in the Emergency Department was busy. When she felt that someone had squeezed up to her, she frowned and turned around impatiently to chase the person away.
However, the moment she saw Su Yun, her face immediately turned red, and she did not know where to place her hands. He didn't dare to look, but he still wanted to look. He was in a complete mess.
"What patient?" Su Yun asked gently.
"He's a postoperative patient sent over from a hospital in a nearby city. He underwent two surgeries, and now, his right chest cavity is occupied." The young nurse did not know much, but she told him everything she knew. She sincerely did not hold back at all.
After saying that, she felt a little ashamed.
He knew too little. This was not right. Sob sob sob ~
"Su Yun, you're here." Zhou Litao heard someone talking beside him. After checking his body, he turned around and saw that it was Su Yun.
"Call me Brother Yun," Su Yun squatted on the ground, looked at the chest bottle, and said softly.
"Brother Yun, the closed chest drainage drew out a small amount of gas. I reckon that there are still damaged areas in the lungs," the young nurse added.
Why was it so hot in April? She felt that her face was so hot that she could not even wear a mask. Hot air sprayed out from the gap of the mask as she breathed, raising the temperature of her entire face by a lot.
'It's all because of this damn weather,' the young nurse thought to herself.
"Cui Lao is in the office." Zhou Litao held a notebook in his hand. There was a stack of A4 paper on it, and he used his own method to record the situation of many patients.
When Su Yun asked him to call him Brother Yun, Zhou Litao acted as if he did not hear it. Every freckle on his tanned face expressed rejection.
He said a few words to the family members and arranged for a doctor from the Emergency Department to deal with them. Then, he went to Cui Lao's office with Zheng Ren and Su Yun.
They knocked on the door and entered. Zhou Litao began to report his medical history.
Cui Lao did not 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. The local hospital diagnosed her with congenital retrosternal diaphragmatic hernia.
Eight months ago, the patient developed progressive dyspnea and palpitations during activity, which worsened for two months. She was hospitalized at the local hospital and underwent surgery.
Report: The intestinal contents in the chest cavity compressed the middle and lower lobes of the right lung, causing atelectasis and mediastinum deviation.
Here are the radiographic films before the patient's first surgery. "
As he spoke, Zhou Litao skillfully took out a bag from the bag of radiographic films and handed it to Cui Lao.
From the details, Zhou Litao was indeed a very capable chief resident of the Emergency Department. With just a short period of understanding the patient's condition and physical examination, he had a basic grasp of many situations. When he reported to Cui Lao, he was also orderly.
Zheng Ren praised him in his heart.
"Continue," Cui Lao did not look at the radiographic films and only said lightly.
"During the first surgery, the mediastinal retrosternal defect was found to have a median diameter of
Most of the hernias included the small and large intestines, as well as the greater omentum. When the right lung was dilated after the hernia sac was removed, emphysema and spontaneous pneumothorax were found. The thoracic department consulted on the emergency table and performed closed thoracic drainage. "
Zhou Litao took the patient's family's copy of the case, quickly flipped to the page of the surgical record, and picked out the key points.
"Six hours after the surgery, closed thoracic drainage drew out a large amount of air. The volume of air was very large. After the thoracic department's consultation, they decided to perform a second thoracotomy for the bullae repair.
"One week after the surgery, the patient suddenly had a respiratory failure. An urgent examination of liver function found that the transaminase was elevated. CT showed that the right lung was compressed again, and a substantial organ entered the chest cavity. It 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 clip and inserted the most recent chest CT radiographic films into the radiographic film viewer.
Without realizing it, he placed his left hand under his right armpit and rested his chin on his right hand. His eyes narrowed slightly as he began to read the radiographic films.
Zhou Litao explained the patient's condition in great detail. There were two surgeries. One was a thoracic surgery, and the other was a general surgery.
Not only did the patient's condition not improve after the surgery, but he also developed a more serious liver hernia.
It was certain that he needed emergency surgery. However, whether it was the thoracic department or the general surgery department, the sense of propriety in between was very subtle.
Ordinary doctors were not willing to take on postoperative patients sent from lower-level hospitals.
That meant a lot of trouble.
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