Detailed Treatment Process
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Female infant, age: 1 year 10 months The baby girl has remained in a vegetative state since undergoing hernia surgery. The following are two complete blood count reports from the day of surgery. First complete blood count report Department: General Surgery Sample type: Blood Report date: November 3, 00:48 White blood cell count: 7.42×10⁹/L Red blood cell count: 5.60×10¹²/L ↑ Hemoglobin concentration: 119.00 g/L Platelet count: 355.00×10⁹/L ↑ Neutrophil absolute value: 4.02×10⁹/L Lymphocyte absolute value: 2.60×10⁹/L Monocyte absolute value: 0.76×10⁹/L ↑ Eosinophil absolute value: 0.00×10⁹/L ↓ Basophil absolute value: 0.04×10⁹/L Neutrophil percentage: 54.30% Lymphocyte percentage: 35.00% Monocyte percentage: 10.20%↑ Eosinophil percentage: 0.00%↓ Basophil percentage: 0.50% C-reactive protein: 5.00 mg/L High-sensitivity C-reactive protein: 4.50 mg/L ↑ Second complete blood count report Patient type: Inpatient (emergency) Department: ICU Age: 1 year 10 months Specimen type: Blood Request time: November 3, 07:51 Receipt time: November 3, 08:40 Report time: November 3, 09:02 White blood cell count: 6.57×10⁹/L Red blood cell count: 5.06×10¹²/L Hemoglobin concentration: 107.00 g/L ↓ Platelet count: 119.40×10⁹/L ↓ Neutrophil absolute value: 4.91×10⁹/L Lymphocyte absolute value: 1.18×10⁹/L Monocyte absolute value: 0.34×10⁹/L Eosinophil absolute value: 0.14×10⁹/L Basophil absolute value: 0.00×10⁹/L Neutrophil percentage: 74.74% Lymphocyte percentage: 18.04%↓ Monocyte percentage: 5.24% Eosinophil percentage: 2.14% Basophil percentage: 0.00% C-reactive protein: 5.00 mg/L High-sensitivity C-reactive protein: 4.00 mg/L ↑ First operative record Department: General Surgery Sex: Female Age: 1 year 10 months Date of surgery: November 3 Preoperative diagnosis: Left inguinal mass, left inguinal hernia Intraoperative diagnosis: Left inguinal mass, left inguinal hernia Operation name: Left inguinal exploration Incision type: I Anesthesia: General anesthesia Operative course The patient was placed supine on the operating table. After successful preoperative safety verification, endotracheal intubation and general anesthesia were performed. After induction of anesthesia, routine skin preparation and draping were completed. Following a second safety verification, a 2 cm incision was made over the left inguinal mass. Upon incising the skin, airway pressure rose and oxygen saturation fell. Suspecting sputum plug causing airway obstruction and bronchospasm, the procedure was immediately terminated and resuscitation measures were instituted. Record date: November 3, 08:00 The above is the first operative record. Second operative record Basic information Department: General Surgery Sex: Female Age: 1 year 10 months Date of surgery: November 5 Preoperative diagnosis: Left inguinal mass, left inguinal hernia Intraoperative diagnosis: Left indirect inguinal hernia Operation name: Reduction of left incarcerated inguinal hernia + high ligation of hernia sac Incision type: II Anesthesia: Inhalational general anesthesia + local anesthesia Operative course The patient was placed supine on the operating table. After safety verification, inhalational anesthesia was induced. After induction, routine skin preparation and draping were completed. Following a second safety verification, local infiltration with 0.1% lidocaine produced satisfactory effect. The original skin incision in the right lower abdomen (note: the record states right, though it should be left) was reopened and subcutaneous tissue divided. The external oblique aponeurosis was opened layer by layer along the surface of the mass, revealing an indirect hernia. Subcutaneous tissue was freed on the superficial surface of the external oblique aponeurosis down to below the inguinal ligament. The hernia sac was identified. After releasing the external ring, the sac was opened, releasing approximately 15 ml of pale yellow fluid. After suctioning the fluid, the hernia contents were found to be part of the ovary and omentum with mild congestion and edema. After releasing the hernia ring, the contents returned spontaneously with no signs of necrosis. The hernia sac was suture-ligated at the ring and the redundant portion excised. There was no active bleeding. After correct counting of instruments and materials, the incision was closed in layers and dressed with sterile gauze. The patient was returned safely to the ICU after a final safety check. The operation proceeded smoothly, anesthesia was satisfactory, and there was no significant bleeding. Record date: November 5, 21:00 The above is the second operative record. First discharge record Department: ICU Sex: Female Age: 1 year 10 months Admission date: November 2 Discharge date: November 10 Hospital stay: 8 days Diagnostic information Admission diagnosis: Left inguinal mass Discharge diagnoses: 1. Left inguinal mass and left inguinal hernia; 2. Upper respiratory tract infection; 3. Pulmonary infection; 4. Hypoxic-ischemic encephalopathy; 5. Secondary epilepsy; 6. Hypokalemia; 7. Status epilepticus Treatment outcome: 1 and 6 improved; 2, 3, 4, 5, and 7 unresolved Hospital course Admission status: The patient was admitted for a left inguinal mass noted more than 4 days earlier. Physical examination: Temperature 37.3°C, weight 10.6 kg. A 2 × 2 cm mass was visible in the left inguinal region with moderate consistency, tenderness, and irreducibility. Surgery and complications: After completion of preoperative investigations, left inguinal exploration was performed under general anesthesia. During anesthesia the patient developed airway spasm. The procedure was terminated after resuscitation, and the patient was transferred to the ICU. Subsequent treatment: Sedation, antiepileptic therapy, dehydration to reduce intracranial pressure, anti-infective treatment, neurotrophic support, and symptomatic care were provided. A second operation was performed on November 5 and proceeded smoothly. Complications: Frequent episodes of secondary epilepsy occurred postoperatively, with apnea during seizures requiring endotracheal intubation and mechanical ventilation. Discharge status The patient remains under diazepam sedation with reduced response to painful stimuli. She is intubated and receiving mechanical ventilation, with some spontaneous breathing. Both pupils are equal and round at 3 mm with absent light reflex. Neck is supple. Breath sounds are coarse bilaterally with scattered dry and moist rales. Bilateral Babinski signs are positive. Physician assessment: The patient’s condition is complex with a poor prognosis. Consultation with external experts recommended transfer to a higher-level hospital. After discussion, the family agreed to transfer and signed the necessary forms. Discharge instructions were to continue treatment at a higher-level facility. The above is the first discharge record. Second discharge certificate Department: Intensive Care Medicine (ICU) Sex: Female Age: 1 year 11 months Admission date: November 10 Discharge date: December 6 Discharge diagnoses 1. Hypoxic brain injury: Status convulsivus Respiratory failure Intracranial hypertension syndrome Brain herniation Cognitive dysfunction Motor dysfunction 2. Severe bronchopneumonia 3. Status post left inguinal hernia repair Treatment course Admission status: Relevant examinations were completed, critical illness notice was issued, and mechanical ventilation was provided. Main medications: Anti-infective: Piperacillin-tazobactam, azithromycin (etiology suggested Mycoplasma positive). Intracranial pressure reduction: Furosemide, mannitol, glycerol fructose. Neurotrophic: Monosialotetrahexosylganglioside, mouse nerve growth factor. Anticonvulsant: Levetiracetam. Hemostatic: Etamsylate, hemocoagulase (CT showed intracranial hemorrhage). Rehabilitation progress: Endotracheal tube removed after 15 days; oxygen discontinued after 16 days; temperature normalized and no seizures after 20 days. Current status: Vital signs basically stable, minimal airway secretions, no further life support required, continued home rehabilitation needed. Treatment outcome and recommendations Treatment outcome: 1. Improved; 2 and 3. Clinically cured. Discharge advice: 1. Continue treatment at the local hospital. 2. Prevent vomiting and choking during nasogastric feeding. 3. Strengthen airway management and nursing care; avoid cold exposure and infection. 4. Initiate rehabilitation training when general condition permits. The above is the second discharge certificate. The child has remained in a vegetative state since the hernia surgery. A judicial appraisal concluded that the hospital bears 25% responsibility. One detail in this case is noteworthy: the first general anesthesia used endotracheal intubation, while the second used inhalational anesthesia. Endotracheal intubation is typically significantly more expensive than inhalational anesthesia.