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October 10th, 2016, in Sanmenxia, Henan, China, because the large hemoptysis might cause asphyxia, a 23-year-old-patient, Zhang, was sent to the ICU.
The CT of patient’s chest shows that there are foreign matters in her lung. Her physician Chaoqian Yuan and chief physician Shelu Chu asked her parent about patient’s medical history.
According to her parents, at two years old, Zhang chased her grandma and tumbled while having meal, when she was picked up, her parents found the chopsticks in her hand was only half left. They thought the other half part might stuck in her throat so they went to the doctor immediately. The doctor said he could see the chopstick vaguely, but he didn't have the equipment to get it out. The parents went to a larger hospital and they didn't see the chopstick in CT. As Zhang could still eat and drink without any symptom, her parents brought her home. Zhang got fever and cough that night and was cured, after this, they never thought about this matter.
Now Zhang is 23 years old, graduated from university and has a job. No one would think of that matter until Zhang cough and was diagnosed large hemoptysis.
After 21 years, that disappeared chopstick was found in Zhang’s lung!
Because of the large hemoptysis, Zhang’s hematochrome was only 6 gram while normal people have above 12 gram.
The surgery has to be operated immediately or she might die because of the asphyxia caused by hemoptysis.
Physician Yuan and Chu called all physicians in Thoracic Surgery to discuss the curing plan.
Plan A:
Save left side lung and cut open it to take out the chopstick.
This plan causes small trauma but the risk is that the chopstick was in Zhang’s lung for 21 years, because of the long time, the chronic trauma and infection have already damage the left side lung. If physicians simply cut open the lung and take it out, it might cause hemorrhoea during the surgery and makes it out of control. On the other hand, the remaining part might keep infecting and might be very dangerous. In this way, Plan A does not work that well.
Plan B:
Cut the lower lobs of left lung and only keep the upper lob.
The risk is that infection from lower lobs has already affected the upper lob, especially the beginning part of the bronchus in lung, making it hard to provide the blood vessel for upper lob for left lung and to anatomy and separate during the surgery. Not only the technical problem would appear, it might also cause hemorrhoea. More importantly, the remaining lower lob is highly likely to infect, breach, bleeding, and might cause empyema and other complications that endanger Zhang’s live. It might need the second surgery to cut the remaining upper lob in left side lung. Plan B has great risk and most likely cannot save Zhang’s live.
Plan C
Cut the whole left lung to reduce the ulterior risk.
Given the situation that the chopstick harms the left lung for 21 years and makes it damaged lung without any functions and makes it no need to save it. It would be better to cut the whole left lung, simplifying the operation and increasing the success rate to save patient’s live. Besides, it is the safest and most efficient plan so far. However, the problem is, the patient is only 23 years old and the sickness is benign. If the whole left lung is cut, is it possible for Zhang and her family to accept this?
Which plan could both save Zhang’s live and do not affect her future live?
After long time discussion and consider the pro and con of this case, the surgical team argued about choosing the plan and caused disagreement on this case.
Studied in Union Medical hospital and working in Department of thoracicsurgery for 20 years, chief physician Shelu Chu decide to invite chief physician from Henan Tumor Hospital for a discussion, and they finally think it would be better to choose Plan C.
Operation Starts
On the morning of 3rd, November, Zhang was sent into the O.R.
In surgery, the first obstacle was anaesthesia. To anaesthetize the patient with large hemoptysis, physicians need double-lumen tube to prevent the hematocele from running into the healthy part of lung to cause the asphyxia. And it requires high skill to operate the double-lumen tube with anaesthesia because the anesthetist has to place both side of DLTs accurately to both sides of the opening of lobar bronchus. Once DLts get to the wrong position, it don't stop the bleeding to the lung but endanger patient’s live. Tao Liu, who is in charge of anaesthesia, because of the well preparation before surgery, he accurately and quickly place the DLTs and makes the operation go smoothly.
Jinlaing Xu, chief physician in department of thoracicsurgery in Henan Tumor Hospital, participate in surgery. Shelu Chu, chief physician in department of thoracicsurgery, operate the surgery. Chaoqian Yuan, Haifeng Cui were in surgery as well.
From the surgery, physicians found that Zhang’s left lung is connected closely to the partial pleura, from the outside partial pleura . Basal segement of lower lobe in left lung, the superior segment of lower lobe, mid-lingual lobe, and part of the posterior segment of the upper lobe become hard, and partial calcification, formed closely connection with posterior chest wall and makes it hard to separate. Inside the lung, the chopstick penetrate the left lung vertically, through both upper and lower lobe, placed next to the aorta pectoralis. It’s very likely to pierce the aorta pectoralis and cause the hemorrhoea.
Although physicians prepared very well and makes the situation very clear to everyone of them before surgery, what they saw is far beyond what they expected.
The left lung is completely damaged and cutting the whole left lung has to be operated immediately with no other options.
Separating the adhesion of anocelia, dissecting and separating great vessels in lung, and then cutting and transfixion, finally physicians cut the primary bronchi of the left lung and remove the damaged lung.
The chopstick penetrating both upper and lower lobe shacks the whole surgical team: it is 12 cm long with part of corrosion and the change of the color.
Success of the surgery
After 3 hours, the surgery finished successfully. Zhang was transferred to ICU to have further treatment. In 5th, November, Zhang’s condition become stable and was transferred to Department of thoracicsurgery to get rehabilitation.
Because of the large hemoptysis, the patient need transfusion. While the blood bank in Sanmenxia is in the shortage of blood, Shelu Chu proposed that staff should donate blood for Zhang to save her life.
Luck beautiful girl with strong will
“the rehabilitation is going pretty well and you could do some exercises tomorrow.” the chief physician Chu said to Zhang.
“She has really strong will. From ICU to rehabilitation, she always smiled.” Says Chaoqian Yuan, the vice chief physician of Department of thoracicsurgery.
“Everytime I cried, she comforted me as if she was the healthy person. Every staff saved her and we own a lot to them.” Said Zhang’s 44-year-old mother.
“Everyone calls her “Lucky girl” ”said Qiuna Chen, the head nurse of the Department of thoracicsurgery.
Mystery
Trachea cannula is a clinical technique and is hard for even a professional anesthetist to place a 12cm long chopstick in the windpipe and lung so accurately without any trauma.
Mystery 1:
The chopstick in Zhang’s mouth broke and accurately penetrate into her windpipe without any trauma.
Mystery 2:
The chopstick penetrated through windpipe and left lung and does not cause the asphyxia.
Mystery 3:
The chopstick penetrated through windpipe but pierce into the left lung which has the greater angle with windpipe compared to the right lung.
Mystery 4:
After the chopstick pierced into her lung, Zhang only got fever and cough that night. And there’s no any symptom till it caused the large hemoptysis 21 years later.
Mystery 5:
The 12 cm long chopstick stayed inside her body for 21 years and it does not affect her growth.
According to Shelu Chu, clinically it is very often to see people eat something by mistake and it is often to see there’s matter in lung or stomach, but mostly there are small stuff with little volume and patients would cough immediately and might cause tracheospasm and asphyxia. But according to Zhang’s parents, she didn't show any obvious condition and she just coughed for a while and then she could eat and drink without any obstacles.
Besides, according to the anatomy, the pattern of the sliding object, the hardness of the object, and the characteristic of zero curvature, the chopstick highly likely to get into the right lung instead of left one.
“I feel like these days are like a dream to me.” Said Zhang, lying on the bed with the great smile.
Zhang’s experience is incredible and we hope this strong-willed beautiful girl could recover soon.
Reminding: These actions might cause children to breath in matters.
On 20th, October, 2016, a boy in Shandong province experienced asphyxia because of the food blocked the windpipe. After physicians’ artificial breathing and the surgery, the boy finally got saved.
In May, 2014, because of the watermelon seed blocked the windpipe, a two-year-old girl experienced breath and heart arrest. After several hours’ life-saving effort, the girl finally revived 36 minutes after the surgery.
On 9th, November, according to the results of searching “matters in windpipe and endanger the live” online, cases like this happens a lot. Chu reminds that eating matters happens a lot to infant or people who want to suicide, and it also happens to normal people, so we should pay more attention to it.
Especially when infants are eating, parents must not kittle them or makes them cry, not to say let them hold chopsticks, spoon, or fork to run. And parents should not force them to take the medicine in case those stuff get into the windpipe. Once the matters get into the windpipe, with the breathing, the matter gets deeper and deeper to the windpipe and cause infant to cough and hard to breath. Some large matter might cause the asphyxia to endanger the live.
“Once those situation happens, people could not have the lucky psychology and they should take action to save themselves or go to hospital immediately.” Says Chu, if patients could cough, they should try to cough as many as they could; if patients could not even cough and with respiratory standstill, that means windpipe gets blocked and extrusion method should be taken to get the matter out. If the patient is a child, people should let it lying and the rescuer should place the hand on the epigastrium to press 6-10 times until the matter get out. Besides, the patient should also be sent to the hospital to get further diagnosis.
Chu also reminds that parents should not let children younger than 5 years old eat jelly, sunflower seeds, groundnut or beans, etc. People should also teach children to not put little toys inside their mouths. Adults should also rid habits of chewing the pen or needle when they are at work.
Below are photos of the removed lung and the chopstick
The CT of patient’s chest shows that there are foreign matters in her lung. Her physician Chaoqian Yuan and chief physician Shelu Chu asked her parent about patient’s medical history.
According to her parents, at two years old, Zhang chased her grandma and tumbled while having meal, when she was picked up, her parents found the chopsticks in her hand was only half left. They thought the other half part might stuck in her throat so they went to the doctor immediately. The doctor said he could see the chopstick vaguely, but he didn't have the equipment to get it out. The parents went to a larger hospital and they didn't see the chopstick in CT. As Zhang could still eat and drink without any symptom, her parents brought her home. Zhang got fever and cough that night and was cured, after this, they never thought about this matter.
Now Zhang is 23 years old, graduated from university and has a job. No one would think of that matter until Zhang cough and was diagnosed large hemoptysis.
After 21 years, that disappeared chopstick was found in Zhang’s lung!
Because of the large hemoptysis, Zhang’s hematochrome was only 6 gram while normal people have above 12 gram.
The surgery has to be operated immediately or she might die because of the asphyxia caused by hemoptysis.
Physician Yuan and Chu called all physicians in Thoracic Surgery to discuss the curing plan.
Plan A:
Save left side lung and cut open it to take out the chopstick.
This plan causes small trauma but the risk is that the chopstick was in Zhang’s lung for 21 years, because of the long time, the chronic trauma and infection have already damage the left side lung. If physicians simply cut open the lung and take it out, it might cause hemorrhoea during the surgery and makes it out of control. On the other hand, the remaining part might keep infecting and might be very dangerous. In this way, Plan A does not work that well.
Plan B:
Cut the lower lobs of left lung and only keep the upper lob.
The risk is that infection from lower lobs has already affected the upper lob, especially the beginning part of the bronchus in lung, making it hard to provide the blood vessel for upper lob for left lung and to anatomy and separate during the surgery. Not only the technical problem would appear, it might also cause hemorrhoea. More importantly, the remaining lower lob is highly likely to infect, breach, bleeding, and might cause empyema and other complications that endanger Zhang’s live. It might need the second surgery to cut the remaining upper lob in left side lung. Plan B has great risk and most likely cannot save Zhang’s live.
Plan C
Cut the whole left lung to reduce the ulterior risk.
Given the situation that the chopstick harms the left lung for 21 years and makes it damaged lung without any functions and makes it no need to save it. It would be better to cut the whole left lung, simplifying the operation and increasing the success rate to save patient’s live. Besides, it is the safest and most efficient plan so far. However, the problem is, the patient is only 23 years old and the sickness is benign. If the whole left lung is cut, is it possible for Zhang and her family to accept this?
Which plan could both save Zhang’s live and do not affect her future live?
After long time discussion and consider the pro and con of this case, the surgical team argued about choosing the plan and caused disagreement on this case.
Studied in Union Medical hospital and working in Department of thoracicsurgery for 20 years, chief physician Shelu Chu decide to invite chief physician from Henan Tumor Hospital for a discussion, and they finally think it would be better to choose Plan C.
Operation Starts
On the morning of 3rd, November, Zhang was sent into the O.R.
In surgery, the first obstacle was anaesthesia. To anaesthetize the patient with large hemoptysis, physicians need double-lumen tube to prevent the hematocele from running into the healthy part of lung to cause the asphyxia. And it requires high skill to operate the double-lumen tube with anaesthesia because the anesthetist has to place both side of DLTs accurately to both sides of the opening of lobar bronchus. Once DLts get to the wrong position, it don't stop the bleeding to the lung but endanger patient’s live. Tao Liu, who is in charge of anaesthesia, because of the well preparation before surgery, he accurately and quickly place the DLTs and makes the operation go smoothly.
Jinlaing Xu, chief physician in department of thoracicsurgery in Henan Tumor Hospital, participate in surgery. Shelu Chu, chief physician in department of thoracicsurgery, operate the surgery. Chaoqian Yuan, Haifeng Cui were in surgery as well.
From the surgery, physicians found that Zhang’s left lung is connected closely to the partial pleura, from the outside partial pleura . Basal segement of lower lobe in left lung, the superior segment of lower lobe, mid-lingual lobe, and part of the posterior segment of the upper lobe become hard, and partial calcification, formed closely connection with posterior chest wall and makes it hard to separate. Inside the lung, the chopstick penetrate the left lung vertically, through both upper and lower lobe, placed next to the aorta pectoralis. It’s very likely to pierce the aorta pectoralis and cause the hemorrhoea.
Although physicians prepared very well and makes the situation very clear to everyone of them before surgery, what they saw is far beyond what they expected.
The left lung is completely damaged and cutting the whole left lung has to be operated immediately with no other options.
Separating the adhesion of anocelia, dissecting and separating great vessels in lung, and then cutting and transfixion, finally physicians cut the primary bronchi of the left lung and remove the damaged lung.
The chopstick penetrating both upper and lower lobe shacks the whole surgical team: it is 12 cm long with part of corrosion and the change of the color.
Success of the surgery
After 3 hours, the surgery finished successfully. Zhang was transferred to ICU to have further treatment. In 5th, November, Zhang’s condition become stable and was transferred to Department of thoracicsurgery to get rehabilitation.
Because of the large hemoptysis, the patient need transfusion. While the blood bank in Sanmenxia is in the shortage of blood, Shelu Chu proposed that staff should donate blood for Zhang to save her life.
Luck beautiful girl with strong will
“the rehabilitation is going pretty well and you could do some exercises tomorrow.” the chief physician Chu said to Zhang.
“She has really strong will. From ICU to rehabilitation, she always smiled.” Says Chaoqian Yuan, the vice chief physician of Department of thoracicsurgery.
“Everytime I cried, she comforted me as if she was the healthy person. Every staff saved her and we own a lot to them.” Said Zhang’s 44-year-old mother.
“Everyone calls her “Lucky girl” ”said Qiuna Chen, the head nurse of the Department of thoracicsurgery.
Mystery
Trachea cannula is a clinical technique and is hard for even a professional anesthetist to place a 12cm long chopstick in the windpipe and lung so accurately without any trauma.
Mystery 1:
The chopstick in Zhang’s mouth broke and accurately penetrate into her windpipe without any trauma.
Mystery 2:
The chopstick penetrated through windpipe and left lung and does not cause the asphyxia.
Mystery 3:
The chopstick penetrated through windpipe but pierce into the left lung which has the greater angle with windpipe compared to the right lung.
Mystery 4:
After the chopstick pierced into her lung, Zhang only got fever and cough that night. And there’s no any symptom till it caused the large hemoptysis 21 years later.
Mystery 5:
The 12 cm long chopstick stayed inside her body for 21 years and it does not affect her growth.
According to Shelu Chu, clinically it is very often to see people eat something by mistake and it is often to see there’s matter in lung or stomach, but mostly there are small stuff with little volume and patients would cough immediately and might cause tracheospasm and asphyxia. But according to Zhang’s parents, she didn't show any obvious condition and she just coughed for a while and then she could eat and drink without any obstacles.
Besides, according to the anatomy, the pattern of the sliding object, the hardness of the object, and the characteristic of zero curvature, the chopstick highly likely to get into the right lung instead of left one.
“I feel like these days are like a dream to me.” Said Zhang, lying on the bed with the great smile.
Zhang’s experience is incredible and we hope this strong-willed beautiful girl could recover soon.
Reminding: These actions might cause children to breath in matters.
On 20th, October, 2016, a boy in Shandong province experienced asphyxia because of the food blocked the windpipe. After physicians’ artificial breathing and the surgery, the boy finally got saved.
In May, 2014, because of the watermelon seed blocked the windpipe, a two-year-old girl experienced breath and heart arrest. After several hours’ life-saving effort, the girl finally revived 36 minutes after the surgery.
On 9th, November, according to the results of searching “matters in windpipe and endanger the live” online, cases like this happens a lot. Chu reminds that eating matters happens a lot to infant or people who want to suicide, and it also happens to normal people, so we should pay more attention to it.
Especially when infants are eating, parents must not kittle them or makes them cry, not to say let them hold chopsticks, spoon, or fork to run. And parents should not force them to take the medicine in case those stuff get into the windpipe. Once the matters get into the windpipe, with the breathing, the matter gets deeper and deeper to the windpipe and cause infant to cough and hard to breath. Some large matter might cause the asphyxia to endanger the live.
“Once those situation happens, people could not have the lucky psychology and they should take action to save themselves or go to hospital immediately.” Says Chu, if patients could cough, they should try to cough as many as they could; if patients could not even cough and with respiratory standstill, that means windpipe gets blocked and extrusion method should be taken to get the matter out. If the patient is a child, people should let it lying and the rescuer should place the hand on the epigastrium to press 6-10 times until the matter get out. Besides, the patient should also be sent to the hospital to get further diagnosis.
Chu also reminds that parents should not let children younger than 5 years old eat jelly, sunflower seeds, groundnut or beans, etc. People should also teach children to not put little toys inside their mouths. Adults should also rid habits of chewing the pen or needle when they are at work.
Below are photos of the removed lung and the chopstick
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