“My father was in critical condition when he came. Now he is recovering very well. I am really touched. Thank you to all the medical staff!” The daughter of a pseudonym) thanked the medical staff again and again. Just two weeks ago, Uncle Li had just experienced the critical moment of life and death. Thanks to the joint efforts of multidisciplinary experts from the Municipal First Hospital, the old man was freed from danger.
Chest pain for a week, dying
On the seventh day of the first lunar month, the 78-year-old Uncle Li suffered from unbearable chest pain for a week and vomited frequently. . Emergency chest and abdomen CT showed: right diaphragmatic hernia, small bowel obstruction at the neck of the hernia sac, right lung atelectasis, pleural effusion, life-threatening! Just six months ago, Uncle Li had just undergone laparoscopic sigmoid resection, terminal ileostomy and liver tumor resection because of colon cancer with liver metastasis.
Because of Uncle Li’s extremely poor physical condition and a long course of intestinal obstruction, it is impossible to know whether there are other life-threatening conditions such as intestinal necrosis and thoracic and abdominal infection. After receiving the consultation notice, Zhang Fuquan, the chief physician of the Department of Thoracic and Cardiovascular Surgery, rushed to the emergency department as soon as possible, and urgently reported to Xu Yiming, the chief physician of the Department of Thoracic and Cardiovascular Surgery. After fully understanding the situation, we learned that the patient’s heart has complete right bundle branch block and left anterior branch block, which means that cardiac arrest may occur during general anesthesia surgery, which is undoubtedly worse.
Multi-disciplinary collaboration, decisive surgery
“This situation can’t wait any longer, surgery must be done immediately!” Xu Yiming, who has completed 3 grade 4 lung cancer surgeries, can’t take a rest, while Arranging the examination, while communicating with the patient’s children, “the only way to save him now is the operation, and if it drags on, the person will die.” After obtaining the unanimous understanding and consent of the patient’s family, Xu Yiming immediately conducted a consultation with Huang Jianfei, the chief physician of the Department of Cardiovascular Medicine. Communicate, plan to have a temporary pacemaker implanted and then prepare for thoracotomy, so as to protect the fragile heart during the operation and prevent it from happening.
Everything was ready, Tai Chenhui, the chief physician of cardiovascular medicine, successfully implanted a pacemaker for Uncle Li, and Xu Yiming led the team to start the intense operation. During the surgical exploration, it was found that more than half of the abdominal organs of the patient, such as the small intestine, part of the colon, mesentery, part of the liver, and gallbladder, had been greatly displaced, all of which were moved to the right thoracic cavity through the damaged diaphragm, and the right lung had even been squeezed and lost. ventilation, which is rare. Feng Shichun, chief physician of gastrointestinal surgery, and Qian Yi, deputy chief physician of hepatobiliary surgery, also rushed to the operating room as soon as possible. According to the comprehensive consultation opinions, the patient’s bowel did not have obvious ischemic necrosis, which is a fortune in misfortune, but at the same time, the neck of the hernia sac is located at the second hepatic porta, the main portal for blood to exit the liver, which compresses the return blood vessels, resulting in obvious congestion of the liver. The surgical team successively returned the bowel, liver and gallbladder to the abdominal cavity by manipulation. After observing for a period of time, it was found that the bowel and liver returning to the abdominal cavity had good blood supply, and finally the diaphragm was repaired with artificial patch.
During the dangerous period of several days after the operation, the thoracic and cardiac surgery medical team gave professional evaluation, treatment and careful care. At present, the patient has been transferred to the general ward of the Department of Thoracic and Cardiovascular Surgery, and all re-examination results suggest a good outcome.
Correspondent Li Weinan
Reporter Feng Qirong