herniation of lung

[Ingram]

I am just a pre-med student, but I felt this is the appropriate forum to post this question. I have been shadowing a older surgeon, now doing general practice, for about a year now. We recently had a patient with a herniated lung. He was working under a truck and felt a tearing pain in his side. He went to the clinic and the doctor ordered some CT's and X-rays. On return of the radiology reports the patient's diaphram and lung had herniated. The lung and diaphram, and currently part of the liver, have all been herniated through a space between the ribs that apparently tore while under the truck. When the patient took off his shirt on his second visit to the clinic you could see the lung expand under the skin on the outside of the ribs. It went from tennis ball sized to softball sized in 1-2 days. Now for my questions.

No surgeon at any hospital wants to do surgery to correct this. Why? (The surgeon that runs the clinic can't do it because he doesn't practice surgery any more.)

Have any of you ever seen this before? (The doctor at the clinic has seen this only once before and it was a patient post-surgery, the stitches didn't hold on that patient. Don't ask me about that patient or that surgery because I don't know anything more than it was some sort of penetrating trauma that herniated the lung 3-4 days post-op.)

any answers or questions welcome.

Ingram

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[Winged Scapula]

You haven't mentioned whether the herniation is anterior or posterior, but if its the latter (which would be the more common certainly, but still rather rare), it could be a Grynfeltt's hernia (superior lumbar triangle). These are not common, but still common enough to get mentioned in most texts.

While I do not know the specific reasons why "no one will touch him", I can imagine its because:

1) unusual hernia, so experience will be small
2) possible difficult exposure
3) some people don't like fooling around with the liver
4) possible patient issues (ie, comorbidities, etc.)

These hernias are usually the result of a traumatic injury, but can be congenital. It doesn't sound as if your patient had any trauma to the area. Interesting case - let us know how it resolves.

 

[toofache32]

While I do not know the specific reasons why "no one will touch him", I can imagine its because:

1) unusual hernia, so experience will be small
2) possible difficult exposure
3) some people don't like fooling around with the liver
4) possible patient issues (ie, comorbidities, etc.)

5) patient doesn't have insurance

 

[Winged Scapula]

5) patient doesn't have insurance

Ahhh...yes, the number one reason! 😉

 

[Celiac Plexus]

5) patient doesn't have insurance

...coming as a 3AM transfer to an academic medical center near you....

 

[Ingram]

I forgot to add that it is posterior. He does have insurance by the way.
The main reason I was asking is because the herniation just keeps getting larger. Frequently he will go into coughing spells and almost pass out (he does turn slightly cyanotic but not much). The university hospital nor the private practice surgeons want to operate, but if it just keeps getting larger and he gets any more anoxic (correct word?) he is going to be in serious trouble. Maybe I am misstaken about that. What do you think?
thanks,
Ingram