Mysore/Mysuru: Doctors of JSS Hospital have saved a teenager from near death after performing rare surgery for multiple complications.

Abhishek, a 19-year-old boy from H.D. Kote and a chain smoker and alcoholic had come to the Hospital with severe abdomen pain since 5 days with vomiting and cough for 3 days. Before he was brought to JSS, he was taken to four different hospitals where proper diagnosis could not be made. He was then brought  to JSS Hospital in a state of shock with cardiac, respiratory and kidney failure. There was blood in the naso gastric aspirate. 

He was immediately put on a ventilator and treatment was started to optimise his blood pressure and to support his heart and kidneys. The CAT scan of the chest and abdomen showed that his stomach and spleen had herniated into his left chest causing the left lung to collapse fully.

A team of super specialists  led by Dr. Shyam Prasad Shetty Bellipady, Dr. K.R. Sujay  Dr. Mahesh S. Shetty,  Dr. Sunil Kumar,  Dr. Dinesk Kumar,  Dr. Murugesh Wali, Dr. Jairaj and Dr. Manjunath Shetty performed emergency operation by opening the chest and abdomen. The stomach, greater omentum and spleen that were inside the left chest (where it is not supposed to be) were reduced back into the abdomen. There was a large defect in this left diaphragm that seemed to be present since his birth, an unusual and rare phenomenon, which was also closed. 

The stomach which was in the wrong site had become non viable and had to be removed and the continuity was re-established by connecting the oesophagus to the jejunum (a second part of the small intestine). Also,  a temporary feeding jejunosotmy was done to help him feed. Treatment was also continued as advised by Nephrologist for his renal dysfunction.

After the emergency lifesaving surgery, Abhishek’s stay in the ICU was uncomplicated and he was taken out of ventilator after two days. He received multiple hemodialysis for his nonfunctioning kidney which slowly recovered. He did very well post surgery and was discharged after 10 days. Now he is back to his normal life. 

Why this case was unusual?

The 19-year-old youth in near death situation came to us with cardio-respiratory distress, metabolic and respiratory acidosis which could not be managed by multiple hospitals. He was later transferred to tertiary care hospital like JSS  Hospital, Mysuru,  which had all the surgical and medical specialties under one roof giving affordable care. 

For a positive outcome of a complex surgical case like this, a good team work is needed, larger team of specialists and varied technology and equipment’s which is not available in most hospitals at affordable cost.

Rare medical condition

Strangulated diaphragmatic hernia is a rare thoraco abdominal complex consisting of distinctive gastrointestinal and cardio-respiratory features. It is a fatal condition unless promptly recognised and surgically treated. This kind of defect can be present at birth or acquired later in life. 

Diaphragmatic hernia is a birth defect where there is a hole in the diaphragm (the large muscle that separates the chest from the abdomen). Organs in the abdomen (such as intestines, stomach, spleen, omentum and liver) can move through the hole in the diaphragm and upwards into the chest causing pressure on the heart and lung, causing the left lung to collapse leading to cardio-respiratory distress.