Surgery saves life of man with stomach inside chest

NAGPUR: Timely action by doctors who operated on a patient with virtually no pulse, very low blood pressure and heart rate due to an unusual condition of a gangrened stomach that had climbed into the chest saved the life of a 71-year-old patient at the Orange City Hospital and Research Institute (OCHRI).
The patient’s condition was so critical that the doctors had got a ‘death on table’ document signed by his relatives before going in for surgery for removing the gangrene from the stomach and bringing all the organs in the chest (lungs and heart) and the abdomen (the digestive system) back to their normal position.The patient also had hiatal hernia, which occurs when a part of the stomach pushes upward through the diaphragm. Hiatus is a small opening in the diaphragm.
“The patient came from Wardha at 9.40pm in the night on September 27. He had no pulse, the blood pressure was 80/60 and the heart rate was 126. The patient was in shock due to toxicity caused from septicaemia. The first X-ray showed the heart almost on the right side of the chest, giving the impression of a birth defect called as dextrocardia (heart on the right side) and leaving us confused on the cause of such criticality,” said Dr Rajesh Atal, an intensivist.
But further investigations cleared the picture. A CT scan showed that the patient’s stomach was severely gangrened and had risen into the chest, almost close to the neck. What made the case more complex was the fact that the stomach and the remaining part of the digestive system had twisted. Also, the heart and lungs were badly pressed due to perforations in the stomach, resulting in leakage of digestive fluids into the abdomen. This was badly hampering blood supply to the heart and lungs, causing breathlessness and low blood pressure and heart rate.
However, after Dr Atal stabilized the vital parameters and Dr Mukund Thakur, a gastrointestinal surgeon, operated on the patient within a few hours of admission, the patient began to respond to the surgery.
“My father had complaints of abdominal pain and acidity for over ten years. We had many sleepless nights despite regular treatment for years. He would walk for some time after each meal. But that day he didn’t walk. He had a vomiting sensation after dinner and put his fingers inside his mouth. Apparently the pressure took his stomach into the chest,” the son told TOI.
The OCHRI team comprised anaesthetist Dr Neeta Deshpande, intensivists Dr N Balankhe, Dr Ashish Shukla, Dr Ganesh Bhure, Dr Ravi Lakhe, Dr Saurabh Rathi, Dr Roshan Jawdekar, Dr Santosh Gadge and Dr Vasundhra Jain, besides medical officer Dr Kavita Durve. Dr Nishikant Lokhande, radiologist, and Dr Milind Pande, a pathologist, carried out the diagnosis.