A hernia is an abnormal anatomy of an organ or tissue in the human body that leaves its normal anatomical position and enters another part of the body through a weak point, defect or pore that has formed congenitally or acquired.

Diaphragmatic hernia is a type of internal hernia, which refers to the disease state in which the abdominal time organs move to the chest cavity through diaphragmatic ectopia, and can be divided into traumatic diaphragmatic hernia and non-traumatic diaphragmatic hernia.

The most common non-traumatic diaphragmatic hernias are hiatal hernias, thoracoabdominal hiatal hernias, parasternal hernias, and absent diaphragm. Hiatal hernia is the most common diaphragmatic hernia in more than 90% of cases and is the most common type of hernia.

In general, a hiatal hernia occurs in the chest cavity through the weak diaphragm of the stomach and intestines.

The most serious complication is hernial sac incarceration, which is strangulated necrosis of the abdominal organs that herniate into the chest.

In this case, emergency surgery is usually required. It would be best if the gastrointestinal tract could restore blood circulation if it didn't last long.

Otherwise, a series of excisions are done to avoid complications such as more severe necrosis and toxic shock.

It's going to be fatal.

However, diaphragmatic hernia is generally herniated into the chest cavity by hollow organs such as the stomach and intestines. For example, the liver, such a large solid organ, rarely has a hernia.

This surgery can be done by either general surgery or thoracic surgery.

So as soon as they heard about the liver hernia, both Zheng Ren and Su Yun were interested, it was too rare, take a look.

What a bullshit $100,000 consultation fee, it was left behind by the two of them in an instant.

Quickly walked to the emergency department, and in the emergency room, a room full of patients' family members, and two out-of-town private 120 medical staff were collecting fees.

Seeing that Zhou Litao was busy with 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 that the condition is very serious.

Seven or eight diagnoses, such as asymptomatic congenital retrosternal diaphragmatic hernia, diaphragmatic hernia repair, liver hernia, falling pneumonia, pericardial effusion, etc., appeared in front of Zheng Ren's eyes.

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

The abdominal organs protrude into the diaphragmatic angle of the thoracic cavity through the thoracic costal triangle, which is called a congenital retrosternal diaphragmatic hernia, also known as retrosternal hernia, parasternal hernia, anterolateral hernia or Morgangri hiatal hernia.

This kind of hernia is relatively rare, accounting for 3%~5% of diaphragmatic hernias. The right side of the chest is more numerous, with respiratory and digestive symptoms.

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

Liver hernia ...... Liver hernia ...... Zheng Ren thought intently.

Su Yun had already come to the patient's side to see Zhou Litao for a physical examination.

The little nurse in the emergency department was busy, and when she felt someone squeezing up, she raised her eyebrows, and she was impatient to drive people away.

But the moment she saw Su Yun, her face suddenly turned red, and she didn't know where to put her hand. I don't dare to look at it, I don't dare to look at it and I still want to see it, it's a tangled mess.

"What patient?" asked Su Yun gently.

"The postoperative patient who was sent to the nearby city hospital had two surgeries and now has a right chest mass. "The little nurse doesn't know much, but she knows as much as she says, and she doesn't really have any reservations.

After saying that, she felt a little ashamed.

I know so little, it's so wrong, 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.

"It's called Brother Yun. Su Yun squatted on the ground, looked at the chest bottle, and whispered in his mouth.

"Brother Yun, closed chest drainage drains out a small amount of gas, and it is estimated that there is still a damaged position in the lungs. The little nurse added.

Why is it so hot in April? She felt that she couldn't even wear a mask with a hot face. The hot air sprayed up through the gaps in the mask as I breathed, raising the temperature of the whole face a lot.

It's all damn weather, the little nurse thought to herself.

"Elder Cui is in the office. Zhou Litao held a notebook in his hand with a stack of A4 paper on it, and recorded many patients' conditions in his own way.

When Su Yun asked him to call Brother Yun, Zhou Litao didn't seem to hear it, and every freckle on his dark face expressed refusal.

He said a few words to his family, arranged for a doctor from the emergency department to deal with it, and then came to Cui Lao's office with Zheng Ren and Su Yun.

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

Cui Lao didn't say anything to Zheng Ren, just glanced at him, and began to listen carefully to Zhou Litao's report.

"The patient, a 55-year-old woman, was diagnosed with a congenital retrosternal diaphragmatic hernia at the local hospital.

The patient developed progressive dyspnea and palpitations with activity 8 months ago, which worsened for 2 months. He was hospitalized in a local hospital and underwent surgery.

Preoperative CT returns: compression of the middle and lower lobes of the right lung by intestinal contents within the thoracic cavity, resulting in atelectasis and mediastinal deviation.

Here is a film from before the patient's first surgery. ”

As he spoke, Zhou Litao skillfully took out a bag from the film bag and handed it to Cui Lao.

Judging from the details, Zhou Litao is indeed a very capable emergency department inpatient. It is only a short period of understanding of the condition and physical examination, and many situations are basically grasped. When reporting to Cui Lao, he was also methodical.

Zheng Ren praised it in his heart.

"Go on. Cui Lao didn't watch the film, but just said lightly.

"In the first operation, the mediastinal retrosternal defect was found to be 7 cm in diameter and herniated mostly into the small and large intestines, as well as the omentum. Recruitment of the right lung after hernia sac resection was given, emphysematous bullae and spontaneous pneumothorax were found. Thoracic consultation on the emergency table and thoracostomy drainage is given. ”

Zhou Litao took the case copied by the patient's family, quickly flipped to the page of the operation record, and picked out the key points.

"Six hours after the operation, the thoracostomy drained a large amount of air. The amount of gas was very large, and after thoracic surgery, it was decided to go to the stage for a second thoracotomy for alveolar repair. ”

"One week after the operation, the patient suddenly had a ventilation disorder, and an urgent examination of liver function found that aminotransferases were elevated. CT showed that the right lung was compressed again, and substantial organs had entered the chest cavity, suspecting liver disease. ”

"The local doctor communicated with the patient's family and advised the patient to visit our hospital. ”

After speaking, 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 right cheek, narrowed his eyes slightly, and began to read the film.

The patient's condition, Zhou Litao described it in detail. Two surgeries, one for thoracic surgery and one for general surgery.

Instead of alleviating from the surgery, the patient developed a more severe liver hernia.

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

Doctors are reluctant to take over post-operative patients from lower-level hospitals.

That means a lot of trouble.

Sogou reading website: