DEAR DR. GOTT: I have been told by my physician that I have a tear in my diaphragm and approximately 1/3 of my liver has gone through it. This was discovered when CT scans were being run to check for infections in my intestines. (I have problems with diverticulitis fairly often but have never had surgery for it.)
After pulling my X-rays and scans from years past, he further stated that it shows up as far back as 2004. (I was told in 2009 when it was discovered accidentally and after I questioned a readout of the scan that was given to me.) At first my family doctor and a specialist didn’t think that it was what it appeared to “possibly” be. I have had no trauma such as an accident but did have my gallbladder removed in 2004.
My doctor is now checking my liver function twice a year and so far everything checks out normal. Surgery hasn’t been recommended unless I start showing severe symptoms such as throwing up blood, severe pain in my chest or problems breathing. When I researched this, everything I found recommended “fixing” it.
I am 70 years old, 5’6” and 183 pounds. I am in otherwise good health. What do you think about surgery before a crisis or should I wait until it is unavoidable? I wouldn’t look forward to surgery but I would like to pick my surgeon and not have to take what is available, possibly by being rushed to the emergency room. I think highly of my family doctor, the GI specialist and the surgeon who all gave me the same advice but should I get another opinion?
DEAR READER: The diaphragm is a thin muscle that separates the lungs from the stomach and other organs below. There is a small sphincter through which the esophagus passes. This is typically the area where problems arise when the muscle doesn’t close properly, allowing part of the stomach to protrude through. This is known as a hiatal hernia.
A tear, on the other hand, is due to trauma, yet you have had none. This leads me to believe that the tear may have occurred during your gallbladder removal. In my opinion, the odds that the surgery and the tear occurred coincidentally in the same year are pretty slim. That said, it is now eight years later and you don’t appear to have suffered any ill effects.
I understand your concern about “waiting and watching” but given your history without problems, I believe your three physicians are likely correct that this is the best option for you. That doesn’t mean, however, that you cannot seek out another opinion and choose your own surgeon. In the event that you do begin displaying symptoms, they will likely begin gradually, allowing you to plan your surgery rather than rushing to the hospital as an emergency patient.
Speak with your physicians regarding your concerns. Ask them why they are recommending waiting when your research indicates that surgical correction is recommended. They likely have a perfectly logical reason.