Stomach, spleen crawling into the girl’s chest

A 13-month-old girl, admitted to Bac Giang Obstetrics and Gynecology Hospital in a state of severe respiratory failure, has a critical prognosis due to a large hole left diaphragmatic hernia.

The doctor checked that the baby’s abdomen was not distended, soft to the touch, poor mobility of the chest wall, fast pulse difficult to catch. The X-ray results did not show the gastric balloon in the lower abdomen, but the abnormal gas bubble in the left lung position and pushed the heart to the right.

Doctors from the Department of Surgery, Emergency Department, Intensive Care and Anti-toxicity Department, Department of Surgery Anesthesiology and Resuscitation had interdisciplinary consultation, diagnosed the child with grade III respiratory failure, left diaphragmatic hernia, large hole, very prognosis. severe, emergency surgery is indicated. At this time, the baby’s blood oxygen saturation was only 87%, requiring mechanical ventilation through an endotracheal tube, intravenous fluids, and sedation.

Doctor Le Cong Tuoc, Director of Bac Giang Obstetrics and Children’s Hospital, on August 6, said that diaphragmatic hernia is a rare and complicated disease. Without experience, the disease is easily diagnosed with other diseases such as pneumothorax or pneumothorax. “This particular case is very critical, if only a little delay will lead to death,” the doctor emphasized.

However, “the surgery encountered many difficulties,” said Dr. Nguyen Van Tra, deputy head of the Department of Anesthesia and Resuscitation Surgery. For anesthesia, the team must closely control hemodynamics, fluids, especially the placement of central venous catheters and arterial catheters, continuously monitor and adjust the appropriate amount of fluid when the child is dehydrated, in shock. stresses your heart.

During surgery, the doctor also discovered that the entire stomach, some loops of intestines including the transverse colon and the spleen all passed through the left hernia hole onto the chest wall, compressing, flattening the left lung, pushing the heart to the right. , causing severe respiratory failure in children, the risk of torsion of the heart stem.

“In order to save the patient, the team carried out to bring the herniated viscera back to the abdomen, create a diaphragm flap, sew up the hernia hole in the diaphragm and place a pleural drainage tube,” said Dr. Department of Surgery, who directly operated for pediatric patients, more information.

After two hours, the patient was out of danger and transferred to the Emergency, Intensive Care and Anti-Poisoning Department for further treatment.

Two days later, the patient regained consciousness, was switched to oxygen mask and fed through a nasogastric tube. Currently, the child’s health is stable after 9 days of surgery. The child is expected to be discharged from the hospital in the next few days.

The team of doctors performed surgery for a child with a large diaphragmatic hernia. Photo: Hospital provides

Diaphragmatic hernia is a disease of the diaphragm that causes the abdominal organs such as the stomach, intestines, liver, spleen to enter the chest through the hernia hole. In young children, diaphragmatic hernia can be a congenital pathology, that is, at birth, the child has a defect in the diaphragm and has symptoms of a diaphragmatic hernia such as respiratory failure…

Children with congenital diaphragmatic hernia often have severe lung damage. The disease is common with a rate of 1/12,500 new-born babies, with a mortality rate of 30 to 50%. Children have symptoms of respiratory failure immediately after birth, shortness of breath, cyanosis, often seen from the first breath, concave abdomen, bulging chest… In this case, doctors recommend pregnant mothers from 5 months onwards. Should go to ultrasound, early detection of pathology for early surgery after birth. Without timely diagnosis and intervention, the risk of death in children is very high.

The case of diaphragmatic hernia is not a congenital pathology, which means that the child’s diaphragm is still formed at birth, but due to a defect in the blood vessels that nourish it, the diaphragm is hypoplastic, as thin as a membrane. This membrane still has the ability to separate the thoracic cavity and the abdominal cavity, but during the child’s development, the diaphragm does not thicken. Therefore, every time the child exerts effort such as coughing or crying loudly, the pressure between the abdomen and the ribcage changes, this thin layer of diaphragm is torn, causing the intestines and other organs such as the stomach and spleen to enter the chest little by little. one. Each time the child breathes, these organs go up into the chest through the hernia hole and get stuck in the abdomen, gradually causing the child to have severe respiratory failure.

Therefore, families need to monitor their health and pay attention to how the child breathes. If abnormality is detected, it should be taken to the hospital early for timely treatment.

Hien Chuc


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