Gou is practicing medicine in the clinic

Although there is a large amount of bloody exudate in the patient's abdominal cavity and intestines, it is still different from major bleeding.

Li Jingsheng believes that even at the current stage, it is still possible to rescue the patient's intestines.

At least as long as the diagnosis of the cause is correct, taking a series of treatment measures in advance is also a positive treatment.After Director Higa opened the patient's abdominal cavity, he only performed a simple hot compress and drug sealing treatment, and it was much better to just close the abdominal cavity.

"Dr. Li thinks it's acute hemorrhagic necrotizing enteritis?"

Director He and Yisuke asked almost in unison.

Neither of them thought about the disease.

Instead, it is believed that intestinal obstruction causes signs of necrosis in some segments of the small intestine.

"I just suspect this disease, not sure."

Li Jingsheng was actually very bold in making this diagnosis.

Because to confirm the diagnosis of this disease, the best way is to do intestinal pathological biopsy.Now that the pathology results have not come out, who dares to confirm the diagnosis?
Director He and his deputy chief physician and attending physicians conducted an intraoperative consultation.

In the end I still couldn't make up my mind.

After half an hour, check the effect of hot compress on the intestinal segment.

Part of the intestinal segment still has no peristalsis, but the color of the intestinal tube has become slightly redder than before.

This also gave Director He and others hope.

Li Jingsheng came closer and carefully observed the condition of the patient's intestines.The circulating nurse stared closely at him, ready to stop him at any moment.

In the operating room, the circulating nurse is like a tigress, treating the entire operating room as her territory.

She will strictly control all kinds of safety management and aseptic operations.

After watching it, Li Jingsheng felt very heavy.

According to his surgical experience, although he could not give good surgical advice, the intestinal peristalsis has not been moving, which is actually a precursor to intestinal necrosis.

In other words, necrosis has begun to occur.

"Xu Yan, call Director Bi and ask for his opinion. Tell him about the situation here and see if he can give you a better solution."

When He Qingzhi couldn't make up his mind, he finally decided to ask Director Bi.

Not long after, the circulating nurse came back from the phone call.

"Director Bi's advice is to try to preserve the patient's small intestine and listen to Dr. Li Jingsheng's opinions as much as possible."

For the first time, she looked at Li Jingsheng with a surprised look.

Perhaps she didn't expect that Li Jingsheng had such a high status in Director Bi's mind.

Not only her, but also several doctors under He Qingzhi were also surprised.

Li Jingsheng participated in this operation basically only as a consulting doctor.

To be honest, these doctors did not pay much attention to Li Jingsheng's opinions.

Even Director He, who was in charge, felt very conflicted.

Because he really didn't have a good plan and couldn't make up his mind, he had to listen to Li Jingsheng's opinions to a certain extent.But it is not easy to adopt and accept Li Jingsheng's opinions.

For example, not long ago, Li Jingsheng suggested that the patient might have acute hemorrhagic necrotizing enteritis, but Director He did not agree.

He proposed to do a pathological biopsy of the intestine, but Director He was also reluctant to agree.

In the end, it was Li Jingsheng who explained a lot and worked hard, and then Director He reluctantly agreed.

"Dr. Li, through hot compress just now, the color of the patient's intestines became a little redder, which shows that there is still hope. I just discussed with several doctors in the team, and you heard it. I plan not to perform intestinal resection, but to A terminal ileostomy is performed, followed by peritoneal irrigation and drainage, directly closing the abdominal cavity. If the patient's condition can improve, his bowels can slowly recover.

what you think? "

He Qingzhi had no choice but to seek Li Jingsheng's opinion.

"I think this method is inappropriate. You want to save the patient's small intestine, and your starting point is very good. However, after the patient's intestinal tube has been heated, some intestinal segments are still unable to peristalsis. If you ask me, the possibility of necrosis in these intestinal segments is very high. .

After the abdominal cavity is closed, if the necrotic intestinal segment is not treated in time, it will directly affect other intestinal segments that may still be salvageable.

Moreover, the patient's condition will further worsen by then, and I don't even know if there will be a chance for a third laparotomy. "

Li Jingsheng also knew that opposing Director He's surgical suggestion in front of everyone was equivalent to going against Director He.

Before opening the abdomen, he also thought about creating a fistula in the terminal ileum, then flushing the abdominal cavity, and then draining it, which was a more reliable conservative plan.

Now that he has seen the patient's intestinal condition, Li Jingsheng feels that this method is not advisable.

Because knowing that the intestine may be necrotic and not cutting it off is almost equivalent to discovering that there is a spark in a place and leaving it alone.In the end, the sparks turned into a prairie fire.If you think about taking care of it at this time, it is already too late.

Rather than doing this, it is better to cut off some intestinal segments that may obviously be necrotic.

"Then let's apply heat for a while and see if it doesn't work. Then we can think of other ways."

Director He had different opinions from him. Now Director Bi had spoken, asking him to listen more to Li Jingsheng's opinions.

He certainly wouldn't dare to act arbitrarily.

If you have no choice, you can only choose to observe again.

Time is passing little by little.

The patient's abdominal cavity remains open and the application of hot compresses to those bowels continues.

Everyone expects a miracle to happen.

The color of the intestines has become slightly redder, which is obviously a good change.

Now, as long as the hot compress is continued to induce peristalsis in the intestines, even slight peristalsis is enough to make all medical staff feel excited.

While waiting, everyone had an in-depth discussion about the patient's condition and treatment plan.

Li Jingsheng still believes that it is very dangerous if the intestines cannot peristalsis.Another hour passed and I checked the condition of the hot compressed intestine.

The color of the intestines is still the same, slightly redder, but there is still no peristalsis.

This disappoints everyone.

"Dr. Li, does the patient's intestines have to be cut?"

Director He asked reluctantly.

"Teacher, after I wash my hands and disinfect my hands, can I touch the patient's intestines?"

Li Jingsheng did not answer immediately, but looked at the traveling nurse.

"why?"

The circulating nurse looked puzzled.

“I may be able to feel the bowel and feel its vitality, so I can develop a treatment plan that is more suitable for the patient.”

Li Jingsheng gave the reason.

"This..." The traveling nurse felt a little weird and looked at Director He.

In the operating room, the person who really has the say is the surgeon.

In other words, we are a team and everyone serves patients.

Whether it is an anesthesiologist, a surgeon, or a circulating nurse, their status should all be equal.

But where there are people, there are rivers and lakes.

There is no doubt that the chief surgeon has the highest status.

"Can Dr. Li really judge the vitality of the intestine by touching it?"

Director He is a surgeon himself, has strong surgical skills, and should have a deep understanding of the feel.

"I don't dare to say that it can definitely be done. How can I put it this way? It's just like how you understand the feeling of the knife during surgery. Through the scalpel, you can feel the depth of the cut and the tissue that is cut. All I can say is , you can give it a try.”

Li Jingsheng replied.

"Then give it a try! Everything is for the patients. As long as it is beneficial to the patients, I support it."

Director He agreed.

After Li Jingsheng cleaned and disinfected his hands, he tried to touch the patient's intestines.

First, palpate the intestinal tube of the normal intestinal segment.

After touching it, he touched the diseased small intestine segment.This time I touched it very carefully.

He even closed his eyes to get a better sense of the feel.

Vision and touch sometimes conflict.

Because the visual impact is stronger, it is easy to cover up part of the touch.

Closing your eyes is equivalent to directly turning off your vision, so you can get a clearer sense of touch.

After careful identification, he found that there was a section in the middle of the ileum of the small intestine that basically had no vitality.There are two main basis for judgment, one is intestinal peristalsis, and the other is the blood supply of intestinal blood vessels.

This section is mostly necrotic.

In addition, two small ileal segments also showed signs of necrosis at a similar location.

There are still some problems with the remaining diseased intestinal segments, but they are not as serious.

[Gastrointestinal diagnosis +1, health +1000].

An ingenious touch diagnosis actually earned him a huge reward of one thousand health points.

This gave Li Jingsheng a little more confidence in his diagnosis.

"Director He, I have finished touching. It is recommended that you directly resect this section of the patient's ileum and then perform an anastomosis. There is also another problem. Although this section of intestine feels energetic, it is much weaker than the normal intestinal section. I I wonder if it will affect the anastomosis effect?”

Li Jingsheng gave his advice very seriously.

"The patient's small intestinal disease is serious, which will definitely affect the anastomosis effect. But I am still confident. On the contrary, the large section of ileum you mentioned is really necrotic. Is it necessary to cut it off?"

Director He asked.

"Yeah, I'm pretty sure their vitality is gone. Cutting it off is far better than not cutting it at all."

Li Jingsheng nodded seriously.

In the final analysis, his status is too low and he has no say in the operating room.

If he were the chief surgeon, he wouldn't need to explain much at all.

As long as you make an accurate judgment, just cut it.

It may take some time for that day to arrive, I believe it won't be too long.

Because he now has his own medical team.

Although it was still very crude, there were only four people in total, and the other two were cobbled together by him.

But this does not hinder Li Jingsheng's growth.

As long as he can receive a steady stream of colonoscopies, his team can become stable and slowly grow.

"Well, I believe you! Because this section of intestines has indeed stopped moving. Your words broke my last bit of luck. Maybe this is not a bad thing."

After hearing this, Director He made up his mind to cut off that section of the patient's intestines.

"Even if this large section of intestine is cut off, it is still unknown whether the rest can be saved. But there is some hope." Li Jingsheng believes that cutting off this section of intestine is definitely the right choice. (End of chapter)