This doctor has a system

Chapter 458 522. In the operating room, resurrection match

"Professor Gao, I'm here to see a patient." Director Liu from the Department of Vascular Surgery called with a very anxious tone, "I can't make up my mind. Come and have a look."

Gao Feng's first reaction was that he had suffered heavy bleeding during the operation, but Director Liu said no and asked him to come directly to the ward.

"The problem of fish bones is quite complicated." Director Liu said to him with a solemn expression.

"What fish bone?" Gao Feng asked.

Things started from 5 days ago.

The Vascular Surgery Department of the Provincial People's Hospital received a special referral: a 76-year-old male patient got stuck on a fish bone while eating fish. He went to the local hospital for emergency thoracotomy to look for fish bones, but could not find them.

However, the doctor on duty saw the patient who was pushed into the vascular surgery ward. Apart from the pain from a surgical wound on his chest, he had no fever, abdominal pain or distension.

The patient's vital signs were all stable and no different from ordinary people.

This left everyone a little confused: Because a small fish bone was opened in the emergency chest, but it has not been found yet, and you have to come to the provincial hospital to continue looking for it?
"That's it." The doctor from the lower-level hospital also came this time. "The old man's condition is quite complicated."

The family members quickly agreed. After all, the patient was admitted to the hospital and the CT scan could still be reimbursed.

Chronic gastritis alone cannot explain the patient's persistent chest pain. The doctor, who was afraid of trouble, might as well just prescribe some medicine and discharge the patient. After all, there was no major stomach problem.

But the patient was lucky because his attending physician was quite responsible.

Shocked, the doctor asked the patient about his medical history again and discovered the culprit: a fish bone.

The children were very filial, so we took him to make an appointment at the local hospital and performed a routine gastroscopy.

He has chronic gastritis and often suffers from abdominal distension and acid reflux. He had been prescribed some drugs in the outpatient clinic before, but they were not effective.

The doctor in charge of the bed was so frightened that he peed and shook her wildly.

Back to 7 days ago, the patient first went to the hospital, but it was not because of this fish bone.

Two days before admission, the patient had eaten fish and got stuck by a spine. At the suggestion of his wife, he immediately swallowed the steamed buns and the foreign body sensation in his throat disappeared, so he thought the fish bone had fallen off.

When collecting medical history at the hospital, the local doctor noticed that the patient began to feel substernal pain 2 days ago, but had no other discomfort.

Soon, the blood test results ruled out cardiac factors, but the speculation of reflux esophagitis still required gastroscopy.

Chest pain requires attention because clinically there are many possibilities such as heart disease and reflux esophagitis.

Although the patient currently only feels dull pain in the chest, if the foreign body is not removed as soon as possible and the fistula continues to grow, it will lead to mediastinal bleeding, aortic rupture, and hemorrhagic shock, etc.;

But here comes the question, where did this foreign object the size of a sewing needle come from?

Therefore, the old man had a gastroscopy as scheduled, but the test results only showed that there was a possibility of gastritis, but there were no other abnormalities, and there were no typical signs of reflux esophagitis.

"Isn't it always like this? I used to eat it with a steamed bun." The patient's wife explained hurriedly.

"I suggest doing a chest CT." The doctor in charge communicated with the family, "Let's see if we can find out any problems."

During further chest CT exploration, everyone saw a thrilling scene: there was a high-density sharp foreign body below the patient's tracheal bifurcation, and the foreign body had penetrated the thoracic aorta, forming an esophageal-aortic fistula.

Doctors from the cardiothoracic surgery department and vascular surgery department quickly arrived at the scene. Everyone broke into a cold sweat and had a new assessment of the condition: the dull pain in the chest was just a symptom, and the patient could die at any time due to heavy bleeding.

On the other hand, it may also damage the aortic intima and cause aortic dissection. Any of the above situations may occur at any time and be life-threatening.

"I didn't feel any discomfort at that time." The old man stuttered when he saw many people surrounding the bed.

How do you say that? Those who love me hurt me the most.
The fish bones did fall out of the esophagus at that time, but they did not go into the stomach together with the steamed buns and be digested as the patients and their families thought. Instead, under the squeeze of the steamed buns, they penetrated the esophagus and pierced the thoracic aorta, forming a Aortoesophageal fistula.

The current situation requires a thoracotomy as soon as possible to fill the fistula and remove the fish bone.

Before discussing the details of the operation, the doctors encountered the first problem: faced with a patient who walked into the hospital and just wanted to do a gastroscopy, were they suddenly told that he needed emergency thoracotomy immediately?
"Of course, I'm not doubting our ability." said the patient's son, Yang Hongyuan, "but this surgery...we didn't have such a plan when we came here."

"The plan can't keep up with the changes." The doctor in charge told him, "Your father's condition is quite dangerous!"

When the condition was critical, the doctors directly showed the CT examination images to the patients and their families, and explained the dangerous situation of the current condition.

Although they were surprised, considering that this fish bone was like a time bomb in the body and could be life-threatening at any time, the patient's family accepted the surgical recommendation and removed it as soon as possible.

So, on the night when the CT examination results came out, the patient was pushed onto the stage and underwent a special thoracotomy.

But what happened next made the doctors in the operating room panic: The chest was opened, where were the fish bones?
After the thoracotomy was performed as planned, a temporary surgical team formed by cardiothoracic surgery and vascular surgery only found the damaged part of the aorta, but not the fishbone shown on the CT scan. After further careful search of the scope that could be explored during this operation, there was still no trace of fish bones.

The treatment team immediately communicated with the family and reached an agreement: repair the damaged aorta first and end the operation as soon as possible. A CT scan will be performed again after the operation to look for the whereabouts of the fish bones.

However, after the operation, the whole-body CT scan only showed that there was a suspicious foreign body in the patient's celiac artery, but its nature and detailed location could not be determined.

The operation is over, but the patient's next course of illness is still unknown.

Fishbones are not fixed and may become displaced during transport or movement of the patient, giving rise to a number of possibilities. If the esophagus is punctured again through the aorta and falls into the digestive tract, it is a more optimistic situation.

However, if it falls into a blood vessel through the aorta and reaches other parts of the body along with the blood flow, it may damage the blood vessel wall and form corresponding arterial dissection, affecting the blood supply of distal organs.

"What should we do?" Yang Hongyuan, the patient's son, was anxious. "How can we pull out this fish bone?"

"We have used all three of them." The doctor in charge was a little embarrassed, "How about... transfer to another hospital?"

Although Yang Hongyuan was disappointed, he also understood that the doctors here had tried their best. After discussing with several brothers, he took the old man to the provincial hospital according to the advice of the doctor in charge.

Director Liu is the expert recommended by the lower-level hospital.

It is extremely rare for fish bones to swim in blood vessels throughout the body. However, Director Liu combed through the previously published cases related to fish bone stuck in the throat and found that there were fish bones that penetrated the aorta or liver through the digestive tract, causing bleeding or abscesses. However, there were no fish bones that penetrated the aorta through the digestive tract and followed the blood flow. A case of wandering in the body. Director Liu was worried and excited at the same time.

The concern is that the patient is older, the condition is a bit complicated, and the risk of surgery is high. The excitement is that if the problem is successfully solved, then publishing an SCI is not appropriate.

The prerequisite for successfully removing the fish bone is to accurately position it first. However, there were no positive signs in the patient's abdominal physical examination, and the fish bones were unclear on the preliminary CT scan.

So the first person Director Liu found was Director Li Xianmin of the Imaging Department.

"Director Li, please think of a way."

"You're still a little troublesome." As soon as Li Xianmin finished speaking, Director Liu ruthlessly complained: "What level are you at? Day by day, you are not needed for small things, but you are not used for big things!"

"Why are you so anxious!" Director Li was unhappy, "When I say it's troublesome, I don't mean it can't be done!"

Don't tell me, Director Li really has a way. After the imaging department processed the patient's CT image and reconstructed it in three-dimensional way, it was found that the fish bone was located in the hepatic artery.

"Old Li, I admit that I was not very polite just now, but you are still quite capable." Director Liu of the Vascular Surgery Department said to Director Li with a flattering look on his face, "After this is over, I will treat you to a drink."

Director Li gave him a proud roll of his eyes.

Director Liu immediately contacted the Ultrasound Department for further positioning to see if the fishbone had punctured the hepatic artery or caused blood supply obstruction.

Ultrasound examination and CT angiography of the chest and abdomen both showed that there was a fish bone-like foreign body in the hepatic artery, which did not cause damage to the vessel wall for the time being, and the exact location of the fish bone was imaged and located.

This result surprised everyone: after 3 days, the fish bone swam from the aorta to the hepatic artery?

It is speculated that due to the large diameter of the aorta and the fast blood flow in the artery, after the fishbone falls into the aorta, it will be washed by the blood flow and reach the distal artery;

It stops at the hepatic artery, which may be about the same diameter as a fish bone.

After learning that the fish bone was in the hepatic artery, doctors at the vascular surgery department had different opinions on whether to remove it immediately.

On the one hand, the fish bone may not always stay in the hepatic artery. If the interval is longer, it may pierce the hepatic artery, or as the blood flow flows into the hepatic artery branches that are thinner and more consistent with the size of the fish bone, it needs to be done as soon as possible. Surgical removal.

However, Director Huang of the department believes that the patient is not suitable for immediate secondary surgery for the following reasons:
1. He just underwent an exploratory thoracotomy a few days ago. He is old. The old man may not be able to handle the surgery immediately at this time.

2. At present, all vital signs of the patient are relatively stable after transfer. Except for wound pain after thoracotomy, there is no discomfort such as fever, abdominal pain and distension. The fish bone in the hepatic artery has not caused damage to the blood vessel wall at this time.

3. Another thing is that the diameter of the hepatic artery is small, and the possibility of the fish bone being displaced again is relatively low.

Director Huang's words were all mature and prudent, and Director Liu immediately chose to accept them. He decided to let the patient rest for a week before performing the second operation.

When the patient's son Yang Hongyuan learned about the patient's current condition and expected surgical plan, he also agreed: He really couldn't stand the second time in a short time.

But again, plans can never keep up with changes. The patient suddenly developed tingling and mild tenderness in the right upper quadrant.

"Well, I suspect that the fish bone has been displaced and is most likely damaging the blood vessel wall." Director Liu said to Gao Feng with a solemn expression, "If not, I will do the surgery now, so I thought I would call you over in advance."

The patient was older, had high blood pressure, and was in poor physical condition. He had just undergone thoracotomy a few days ago and was very weak. Going to the operating table now was obviously very risky.

"The main reason is that I'm afraid of bleeding, and I want to find out the truth from you." Director Liu said.

"Okay, I have time." Gao Feng said.

Director Liu immediately communicated urgently with his family member, Yang Hongyuan, and told him that surgery was needed in advance, and that he did not dare to say anything too harshly.

"Little Yang, let me tell you, you may not be able to find the fish bone during this operation, because the fish bone itself may have been displaced and may wander to other places at any time during the operation."

"Then..." Yang Hongyuan was very confused. Anyone who hears the doctor tell you this will feel anxious.

But he was still more decisive, "Director Liu, to be honest, I don't understand much, but I believe you." He signed the letter simply, "If anything, it's fate. Just do your best."

Even though Director Liu has been practicing for decades, he felt warm in his heart when he heard these words. He was determined to do his best to perform this operation well.

He immediately summoned the best soldiers in the department, and also requested assistance from the cardiothoracic and general surgery departments. The third step was to call Gao Feng over.

That afternoon, after everything was ready, the patient was pushed into the operating room.

Yang Hongyuan watched the door of the operating room being closed, feeling extremely worried. The relationship between father and son was quite deep.

Among the three brothers and sisters, he has the lowest academic level. After graduating from technical school, he worked with others for several years and then opened a small machine repair shop in the county.

The eldest brother is an electrical engineer and is currently on a business trip to a small African country. The situation there is quite chaotic. He won't be able to return to the country for a while, so he can only send money and worry about it.

My younger sister rushed back from the capital, but she has a quick temper and is as unreliable as an ant on a hot pot when things happen.

Now it was up to him, the most hopeless child, to make decisions.

Thinking of this, he took out his mobile phone and sent a message to Moments: Dad, come on! The accompanying picture is a photo of an old man with a smile on his face.

Soon someone posted a reply below.

"Brother, what game did my second uncle play? Where did he play?" asked my cousin.

This little guy knows how to play games every day! Yang Hongyuan took a deep breath and replied: In the operating room, the resurrection match.

The phone rang within a few minutes and it was my aunt.

"What's wrong with your dad? Why are you still in the operating room?" The aunt was anxious, "Why didn't anyone tell me?"

"It's not that you are all in your hometown." Yang Hongyuan said, "Why bother you." My aunt's family is growing cotton in XJ. It's too far to go back and forth, and Yang Hongyuan's father specifically told them not to tell them.

(End of this chapter)