Chapter 959: Two Operations
Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
Hernias were abnormalities in which an organ or tissue leaves its normal anatomical position and passed through a congenital or acquired weakness, defect, or pore into another part of the body.
Diaphragmatic hernias are a type of internal hernia that refers to the condition in which an organ, such as the abdominal cavity, moves into the thoracic cavity through an ectopic position of the diaphragm. They can be divided into traumatic diaphragmatic hernia and non-traumatic diaphragmatic hernia.
The most common non-traumatic diaphragmatic hernia is esophageal hiatal hernia, thoracoabdominal hiatal hernia, parasternal hernia and diaphragmatic defect, etc. Esophageal hiatal hernia is the most common diaphragmatic hernia; it is the most common kind of hernia by 90%.
Under normal circumstances, esophageal hiatal hernia will have the gastric and intestinal tract through the weak part of the diaphragm in the chest.
The most serious complication is hernia sac incarceration — hernia into the chest of the abdominal cavity organ strangulation-type necrosis.
In this case, emergency surgery is usually required. If the incarceration does not last long, the gastrointestinal tract can still restore blood flow, which is the best.
Otherwise, a series of resection is needed to avoid more serious necrosis and complications such as toxic shock from infection.
This can be fatal.
However, diaphragmatic hernia usually involves the gastric, intestinal, and other hollow organs that are herniated into the chest. For example, it was rare for a solid organ such as a liver to have a hernia.
This type of surgery could be performed by the General Surgery Department or the Thoracic Surgery Department.
Therefore, both Zheng Ren and Su Yun became interested when they heard about a liver hernia. It was too rare, so they went to take a look.
The 100,000 USD consultation fee was instantly thrown to the back of their minds.
They walked quickly to the Emergency Department. In the resuscitation room, there was a room full of patients’ family members. There were also two overseas private medical staff who were collecting fees.
Seeing that Zhou Litao was busy with the physical examination, Zheng Ren did not call for him. Instead, he began to observe the patients.
The background of the patient’s System panel was bright red, which meant that the patient’s condition was very serious.
Seven or eight diagnoses, such as asymptomatic congenital retrosternal diaphragmatic hernia, diaphragmatic hernia repair, liver hernia, prolapsed pneumonia, pericardial effusion, and so on, appeared in front of Zheng Ren’s eyes.
It was a retrosternal diaphragmatic hernia. Zheng Ren seemed to have guessed something.
The abdominal organs penetrated through the thoracic rib triangle into the thoracic and diaphragmatic angle, which was called congenital retrosternal diaphragmatic hernia. It was also known as retrosternal hernia, parasternal hernia, or anterolateral hernia.
This kind of hernia was relatively rare, accounting for 3% to 5% of the diaphragmatic hernia. The right side of the thoracic cavity was more frequent, and the main symptoms were respiratory and digestive system.
However, the organs that were herniated into the chest were still mainly in the gastrointestinal tract, and the liver was relatively rare.
Liver hernia… Liver hernia… Zheng Ren focused his mind and thought.
Su Yun had already moved over to the patient’s side to watch Zhou Litao perform a physical examination.
The young nurse from the Emergency Department was busy. When she sensed that someone had squeezed in, her eyebrows shot up. She turned around impatiently and wanted to chase the person away.
However, the moment she saw Su Yun, her face instantly turned red, and she did not know where to place her hands. She did not dare to look at him, but she still wanted to look at him. She was in a complete mess.
“What patient?” Su Yun asked gently.
“A postoperative patient sent from a nearby city hospital. He underwent two operations. Now, the right side of his chest is occupying the space.” The young nurse spoke as much as she knew. She did not hold back at all.
After she finished speaking, she felt a little ashamed.
She knew so little. This was all wrong.
“Su Yun, you’re here.” Zhou Litao heard someone speaking beside him. After the body examination, 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 drainage of the chest cavity draws 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. As she breathed, hot air gushed out from the gap of the mask, raising the temperature of her entire face by a lot.
‘It was all because of this damn weather,’ the young nurse thought to herself.
“Cui Lao is in the office.” Zhou Litao held a folder in his hand. There was a stack of A4 paper on it. He used his own method to record the situation of many patients.
Zhou Litao acted as if he did not hear Su Yun asking him to call him Brother Yun. Every freckle on his tanned face indicated that he refused.
He spoke to his family for a while and arranged for a doctor from the Emergency Department to deal with him. Then, he went to Cui Lao’s office with Zheng Ren and Su Yun.
He knocked on the door and entered. Zhou Litao began to report his medical history.
Cui Lao did not say anything to Zheng Ren. He only 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.
“The patient developed progressive dyspnea and palpitations when she was active eight months ago, which worsened two months ago.
“She was hospitalized at the local hospital and underwent surgery for treatment.
“The preoperative CT report: the intestinal contents in the chest compressed the middle and lower lobe 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 very 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. It was only a short period of time to understand the condition of the patient and to conduct a physical examination. He had a basic grasp of many things. When he reported to Cui Lao, he was also methodical.
Zheng Ren praised him in his heart.
“Continue.” Cui Lao did not look at the scans and only said faintly.
“During the first surgery, the median diameter of the defect behind the mediastinal sternum was found to be seven centimeters. Most of the herniations included the small intestine, the large intestine, and the greater omentum. When the right lung was dilated after the hernia sac was removed, emphysema and spontaneous pneumothorax were found. On the emergency table, the Chest Department consultation was performed, and the thoracic cavity was closed for drainage.”
Zhou Litao took the patient’s family’s photocopy of the case and quickly flipped to the page of the surgical records, picking out the key points.
“Six hours after the surgery, the thoracic cavity closed for drainage drew out a large amount of gas. The volume of gas was very large, and after the thoracic surgery consultation, it was decided to go on stage for the second time to open the chest and perform a large alveolar repair.
“One week after the operation, the patient suddenly had a ventilation problem. An urgent examination of the liver function showed 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 suggested that the patient come to our hospital for treatment.”
After saying that, Zhou Litao put down the medical record clip and inserted the latest chest CT film into the radiographic film viewer.
Without realizing it, Zheng Ren placed his left hand under his right armpit and rested his chin on his right hand. He narrowed his eyes slightly and began to read the film.
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 even had a more serious liver hernia.
It was certain that he needed emergency surgery. However, the sense of propriety between thoracic surgery and general surgery was very subtle.
The average doctor was not willing to take over the postoperative patients sent by the lower hospitals.
That meant a lot of trouble.