Cover News Reporter Zhou Jiayi
Recently, a special patient came to the outpatient clinic of hepatobiliary surgery of Sichuan Provincial People's Hospital. The patient, Ms. Li (pseudonym), 31 years old, developed epigastric pain and discomfort more than 7 months ago, which has persisted ever since. Two weeks ago, he vomited blood again.
The staff of the whole department discussed this case and analyzed the doubts and difficulties during the operation
More than 7 months ago, Ms. Li embarked on the road of seeking medical treatment from the beginning of abdominal pain, and after many places successively, after diagnosis and treatment according to "pancreatitis" and "anemia", the effect was still not good. Each time, as long as the condition was relieved slightly, it soon recurred. And as the course of the disease progressed, she not only felt pain and discomfort in her upper abdomen, but also aggravated fatigue, fainted several times, and even suddenly vomited blood. The torment and unknown cause of the illness made her and her family feel very distressed and anxious.
After coming to the Provincial People's Hospital, after being admitted to the hospital by doctors, after detailed examination and consultation, the diagnosis was finally confirmed, and Ms. Li suffered from "pancreatic portal hypertension" and "splenomegaly with hypersplenism". At the same time, the doctor also unexpectedly discovered that Ms. Li's internal organs were reversed and she was a "mirror person".
Professor Gong Jun, Professor Xu Jian, and the attending physician team of Lu Xiangyu joined hands to perform the operation
Gong Jun, chief physician of the Department of Hepatobiliary Surgery of Sichuan Provincial People's Hospital, introduced that "mirror man" refers to the position of human heart, liver, spleen, gallbladder, pancreas, spleen and other organs is completely opposite to that of a normal person, just like looking in a mirror, so it is also called "mirror man". There is no scientific conclusion on the cause of the phenomenon of "mirror man". Current research suggests that "mirror humans" may be related to genetic mutations during human embryonic development, and the probability of their occurrence is about 1 in 1 million.
If the surgery is not performed, the patient may have repeated pancreatitis, splenomegaly with hypersplenism, and in severe cases, it can progress to necrotizing pancreatitis and gastrointestinal bleeding, which is life-threatening. However, surgery is rarely performed for patients with total visceral inversion, and partial pancreatic resection with splenectomy is rare. At the same time, the surgical equipment is designed according to the direction of the internal organs of normal people, and the doctor's operating Xi habits and skills are also from normal people, and the surgeon needs to have a proficient grasp of anatomical variation, ergonomics and reverse anatomical operation when targeting "mirror man" patients, which greatly increases the difficulty of surgery.
Despite this, in order to relieve the patient's pain, the hepatobiliary surgery team decided to rise to the challenge. Zhang Yu, director of the Department of Hepatobiliary Surgery, organized the staff of the whole department to discuss the case, analyze the doubts and difficulties during the operation, accurately locate the anatomical position of the patient's pancreas, spleen, stomach, etc., formulate a detailed surgical plan and emergency plan, and make full preparations.
On December 26, 2023, after completing a comprehensive preoperative evaluation and examination, the team of attending physicians of Professor Gong Jun, Professor Xu Jian, and Lu Xiangyu jointly performed "distal pancreatic resection + total splenectomy + pancreatic pseudocyst resection + partial gastric fundus resection + gastric wall repair + peripancreatic necrotic tissue removal + diaphragm repair + intestinal adhesion release" for the patient. The adverse effects of complete inversion of the spleen and extensive adhesions in the abdominal cavity caused by splenic intervention, strict control of bleeding, accurate anatomical positioning, and smooth reverse operation, which were successfully completed after more than 4 hours, and the patient's vital signs were stable after surgery. After follow-up treatment and rehabilitation training such as anti-infection, acid suppression and nutritional support, the patient was able to get out of bed and move on his own 3 days after surgery.
On January 5, 2024, Ms. Li recovered well and will be discharged from the hospital.
The patient was able to get out of bed on his own 3 days after surgery
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