White armor

Chapter 88 Diagnosed, abdominal cocoon syndrome!

Luo Hao was also helpless.

Abdominal cocoon syndrome is relatively rare. Professor Lei’s diagnosis error is not a problem, but his attitude is a big problem.

Why is it like he jumped into a well with his child in his arms? Isn't it just a diagnosis? Luo Hao couldn't understand.

"What do you suggest? What's your surname?" Professor Lei fired directly, extremely irritable.

Luo Hao's expression was as sculptured and did not change at all, "Teacher Lei, you..."

"What am I! What subject are you in? Come and give us gastrointestinal advice!"

Professor Lei opened fire from the commanding heights of the hospital department system, and Luo Hao was helpless.

Although the system did not issue a task, I saw the patient and couldn't just let it go.

In fact, Professor Lei’s diagnosis cannot be said to be wrong.

Abdominal cocoon is also a type of intestinal obstruction.

It is a rare, special type of intestinal obstruction with unknown cause.

It was first reported and named by Foo in 1978.

There is a lack of clinical understanding, diagnosis is often difficult, and the prognosis is generally poor.

If you want to treat abdominal cocoon, intubation and decompression are of no use at all and are just a waste of time.

Of course Luo Hao can do what he can do, and "brush up" the surgical volume. This is the easiest way.

But Luo Hao would definitely not perform unnecessary surgery. This was the most basic matter of principle.

"Teacher Lei, please listen to my explanation." Luo Hao said gently.

"Explanation? What explanation do you have? You don't even have the qualifications to consult in the interventional department. What are you doing in our gastrointestinal surgery department?"

Professor Lei seized the qualification and dealt with it.

Luo Hao shrugged, spread his hands, and looked at the sky.

"Professor Lei, are you sure?" Luo Hao's smile faded a little and he asked gently.

"I'm really not sure it's any of your business, bite me if you can!" Professor Lei stared at Luo Hao fiercely, then turned around and returned to the duty room.

Professor Lei was holding back his breath.

If you have no hair on your mouth, you will not be able to do things well.

The boy named Luo Hao gave him a humiliation and asked him to perform the operation, but he actually started to criticize the diagnosis.

Oh shit!

……

When Luo Hao saw Professor Lei returning to the duty room, he turned around and took out his mobile phone.

"Teacher Chen, it's me, Luo Hao."

Luo Hao first briefly reported on the patient's condition.

"Corey's diagnosis is correct. It is indeed intestinal obstruction, but I think it is abdominal cocoon syndrome, which is very rare in intestinal obstruction. Teacher Chen, I have collected some information on abdominal cocoon syndrome in the past few years and am preparing to publish a paper. "

Luo Hao spoke very quickly, without giving Chen Yan a chance to react, and directly raised the topic of the paper.

There was brief silence on the other side of the phone.

"Xiao Luo, your paper on abdominal cocoon syndrome? Prepare to submit it to a journal with the prefix "Chong". That makes no sense." Chen Yan said lightly.

"No, Teacher Chen, there are two projects. One is an analysis of surgical approaches for young women suffering from abdominal cocoon, and the other is a case report. Are you interested? "The Lancet", first author .”

"What if you make a mistake in your diagnosis?"

On the phone, Director Chen Yan and Chen's breathing became a little thicker.

"That's my fault. There is no case report or review paper. I apologize as the first author. Data on 9 patients have been accumulated. I have obsessive-compulsive disorder and have always wanted to collect 10 cases."

"Okay, I'll go take a look."

After hanging up the phone, Luo Hao breathed a sigh of relief.

Let’s start with the stage. Most young women suffering from abdominal cocoon are weak in constitution and will become seriously ill in the later stages. There are many postoperative complications and a high mortality rate.

It is much better to open the station early and solve the problem early than to delay it for three to five or seven days.

At least, it will be much better from the perspective of patient prognosis.

As for the diagnosis, Luo Hao made his own judgment, and the auxiliary diagnosis AI also gave a definite diagnosis. The misdiagnosis rate should be extremely low, not to mention none.

Luo Hao returned to the doctor's office, and the hospital manager kept staring at Luo Hao.

"Mr. You, what's wrong?"

"Little Luo, I heard someone talking about you. You didn't agree to Xie He's offer to keep you?"

Mr. You used questions.

Obviously, he wasn't sure.

This "rumor" was so unbelievable that Mr. You always felt that it was not true.

How much water is there in the brain for such a thing to happen?

"I'm not good enough, and I miss home, so I went back to Donglian."

"Huh? It's true! No matter how many people want to stay in Xiehe, they can't. What are you thinking?"

Luo Hao smiled and remained silent.

Seeing that Luo Hao didn't answer his question, Mr. You didn't care.

He smiled and said, "Ronald, the patient has intestinal obstruction, so there is no need to be so nervous. The mass is considered to be caused by gas accumulation in the intestine. In fact, your interventional department is particularly suitable for intubation and decompression. Professor Lei's level is not low, you can tell .”

"Yeah." Luo Hao responded.

"Is it abdominal cocoon syndrome? Although it is considered a side effect for adolescent females, it is a rare disease after all and is generally not considered clinically."

"The patient was in severe pain and had symptoms of shock."

“If it doesn’t work, we can only try using laparoscopy first.” Mr. You said, “Professor Lei’s single-port laparoscopy is really good at relieving intestinal obstruction.”

Luo Hao gave Mr. You a kind smile.

This person has been making insinuations to persuade him, and Luo Hao feels that he has good intentions.

"Professor Lei has a bad temper, especially recently...cough cough cough." Mr. You coughed a few times and did not continue.

Luo Hao probably had other problems that he couldn't tell himself.

"If something goes wrong, you can go to surgery at any time. I have already informed the operating room and the emergency department will be open at any time."

"Xiao Luo, Professor Lei usually talks like that, don't be angry. After the operation is completed, you can find a time to apologize. Let this matter be over. Professor Lei will not hold a grudge."

"Why don't you try emergency intubation and exhaust first? It won't take long. I'll do the preoperative preparations. Even if you're right, it won't delay the patient's surgery and treatment."

"Mr. You, it's really useless." Luo Hao replied seriously.

Mr. You smiled and shook his head and asked the doctor on duty to write the medical record. He was looking at something on his mobile phone.

After more than ten minutes, Mr. You raised his head and said, "Xiao Luo, if you don't want to do anything, go back and rest. There is no need to stay here with me in the middle of the night. I'll wait half an hour to take a look. If it doesn't work, just call Professor Lei." Get on stage.”

"I called Teacher Chen, he should be here soon."

"Teacher Chen?" Mr. You was stunned for a moment, and then he understood that Luo Hao was calling Director Chen Yan.

!!!

Mr. You looked at Luo Hao with surprise.

Does he really think Director Chen is easy to talk to? After a few nice words, this guy actually took them seriously and even "gathered" Director Chen from home in the middle of the night.

The ignorant are fearless. Does he know that he is not Director Feng Zixuan?

According to legend, this person seems to have something to do with Dean Jin.

"Little Luo, I heard..."

Just as Mr. You was about to ask, footsteps came from the corridor.

"Mr. You!"

Uh...it's Director Chen's voice.

Mr. You immediately stood up and strode out of the office.

"Director Chen, why are you here?"

"Where's Ronaldinho."

"Director Chen, I'm here." Luo Hao looked down at Chen Yan.

Too short... Luo Hao felt it was impolite to lower his head and wanted to bend his knees and look straight, but that would be too weird and too deliberate.

Forget it, just keep your head down, Luo Hao thought.

"Go and see the patient." Chen Yan didn't hesitate and went straight to change his clothes and then see the patient.

The patient was in severe pain, and within half an hour, his blood pressure began to fluctuate.

In particular, the patient's pulse pressure difference has been reduced to less than 20mmhg.

Pale complexion, irritability, clammy limbs, cold sweat, rapid heartbeat, strong pulse, unstable blood pressure, high and low, small pulse pressure difference, thirst, and oliguria.

This series of symptoms points directly to neurogenic shock.

"Getting ready to go on stage, where is Professor Lei?" Chen Yan asked seriously.

"I'm resting, director. I've already said hello to the operating room and will come at any time. The patient was in good condition when he first arrived..."

"Send the patient away." Chen Yan turned around and said, "Xiao Luo, come with me. Mr. You, call me after you finish the disinfection."

"Okay."

Mr. You sent the patient to the operating room. He was a relatively shrewd and capable resident and had already prepared for the operation.

Luo Hao and Chen Yan came to the director's office.

"Ronald, you are too tough." Chen Yan sat down, his short legs unable to reach the ground and swaying.

"Director Chen, it's really abdominal cocoon syndrome."

"Ha." Chen Yan smiled, the laughter was very cold, his face was full of beard and he was pointing at Luo Hao like a spear or a halberd.

"Ronald, I know you are very skilled in endoscopy and may have your own understanding of the gastrointestinal tract, but that is the endoscopy room and the work of the gastroenterology department and has nothing to do with my gastrointestinal surgery."

Luo Hao was silent, smiled, and listened quietly.

"The patient is considered to have intestinal obstruction, but the rare abdominal cocoon is not considered. Even if it is abdominal cocoon, what can you do?"

"In the provincial capital, I am the only one who can suffer from abdominal cocoon syndrome!"

Luo Hao suddenly became interested.

"Teacher Chen, how many cases have you done? Do you have any medical records?"

"I have no shortage of articles. Good clinicians do scientific research. What we have to do is lead the team, perform operations, treat diseases and save lives."

Chen Yan said seriously.

Every word he said was harsh, whipping Luo Hao like a whip.

"Oh, that's a pity." Luo Hao seemed not to hear the thorn in Chen Yan's words, and said regretfully.

"You were born in Xiehe, where we see a lot of difficult and complicated diseases." Chen Yan stared at Luo Hao, "But not all diseases are considered difficult and complicated, and the soldiers are impermanent, the water is impermanent, and abdominal cocoons can still be operated on. Choice of approach? What a joke."

Although Chen Yan did not point to his nose and tell Luo Hao to get lost like Professor Lei, he scolded him sternly.

Luo Hao didn't speak, just listened.

Less than twenty minutes later, Chen Yan's cell phone rang.

"Let's go to the operation." Chen Yan jumped down from the chair and said coldly, "Xiao Luo, I suggest you don't be too clever. You can publish "The Lancet" if you want? It's the first author. A little favor won't sway me."

"I came here to take a look for Director Feng's sake. Otherwise, on the first day you come to the First Hospital of our Medical University, directly rejecting your idea may be detrimental to your future development."

Luo Hao remained silent and followed Chen Yan to the surgery room to change clothes.

As for Chen Yan's boastful words, Luo Hao didn't take a word of it to heart.

Is the first author of "The Lancet" still a small favor? If it were Mr. You, he would be able to give him a hard time.

The operating room of the First Hospital of the Medical University is on the third floor, close to the intensive care unit, blood bank, emergency laboratory department, and supply room.

From the overall layout and planning, you can tell that it is a new building that is about 5-10 years old.

Entering the emergency operating room, Mr. You and Professor Lei were preparing endoscopic equipment.

The circulating nurse moved three footstools and placed them in the corner, ready for Director Chen to take the stage. Chen Yan stood in a place out of the way with his hands behind his back, saying nothing.

"Director, I'm playing a single hole." Professor Lei glanced at Luo Hao.

"Well, let's go in through a single port." Chen Yan responded, and then said to Luo Hao, "Xiao Luo, your laparoscopy can't treat intestinal obstruction, right? It's basically open laparotomy?"

"It's okay. We rarely do intestinal obstruction. We usually send patients from the emergency department for intestinal obstruction that nearby cities don't dare to open. There are laparoscopy and laparotomy, depending on the situation."

???

Chen Yan was talking about the mining manager of Donglian City, but Luo Hao answered Xiehe.

Damn, you can really pretend!

Chen Yan cursed in his heart.

"However, laparoscopy is rarely done, and most patients require laparotomy. The patient's intestinal wall is very thin and fragile, and laparoscopy can easily cause side injuries."

Luo Hao said softly.

Chen Yan's beard was completely covered by the mask. He had to wear an N95 during surgery.

But after listening to Luo Hao's words, the n95 had been poked with hundreds of holes, leaking air everywhere.

"Oh, if you can't do it, you can't do it. What's the point of talking about Concorde?" Professor Lei said scornfully, "No matter how good Concorde is, why don't you stay there? Is this a place where you come to rescue me? To rescue an intestinal obstruction?"

"Let's go." Although Chen Yan was displeased, he still interrupted Professor Lei's nagging.

Chen Yan saw Feng Zixuan's attitude towards Luo Hao, and he knew the importance in his heart.

Offending a young man like Luo Hao for no reason would do him no good.

So Chen Yan was going to slap Luo Hao in the face with the facts and tell him to retreat and stop pointing fingers.

Seeing the operation begin, Chen Yan walked forward with his hands behind his back and came behind Professor Lei.

"Director." The circulating nurse moved the footstool to the most suitable position.

Chen Yan stood on the footstool, just enough to see the screen between Professor Lei and Mr. You.

"what?"

When the camera came in, Chen Yan let out a sigh.

The field of vision was all white, and the familiar local tissue structure of the intestine could not be seen.

"What is this?" Professor Lei was stunned when he saw this.

Chen Yan didn't speak, and watched quietly as Professor Lei scanned the surgical area with a mirror.

A layer of gray-white, tough, and hard fibrous outer membrane wraps the intestines like a wall. Nothing can be seen under the lens, only a gray patch.

Within a few minutes, Professor Lei's surgical gown was soaked with sweat.

He had never seen anything like this before, and he didn't dare to move at all.

Who knows how thick the gray-white, tough, and hard fibrous outer membrane is, and who knows how thin the intestinal wall beneath the fiber envelope is.

What if the pliers go down and the intestinal wall is punctured by yourself, and all the roast duck cover flows into your stomach?

After being in a daze for a few seconds, Professor Lei turned around and said, "Director, look..."

At this moment, he felt that it was perfect to have the director taking the blame for him, and that troublesome boy was not without merit.

"If you want to switch to laparotomy, you should explain it to the patient's family."

"Excuse me, director." Mr. You immediately replied.

Director Chen turned around and got off the footstool and went to wash his hands in the bathroom.

The surgical procedure was changed from laparoscopic to laparotomy.

Fortunately, I only had one eye punched before, and it was still at the belly button, so it didn't affect anything.

Chen Yan washed his hands, disinfected them, put on clothes, and put on gloves. The three footstools had already been set up. He climbed up the steps, stood on the footstools and stretched out his hand.

The scalpel was clapping in his hand.

Chen Yan hesitated and made a 15cm incision.

The incision was a bit long, but Chen Yan just saw a layer of gray-white tough, thick and hard fibrous outer membrane through the lens, and felt a little guilty.

It was bragging to say to Luo Hao that if the patient had abdominal cocoon, only he could do it in the province, Chen Yan didn't think Luo Hao had a chance to expose him.

But when he saw the gray-white tough, thick and hard fibrous outer membrane, he felt a little regretful.

At this moment, Chen Yan was a little upset.

I hope it's just exudation, and I can peel off the fibrous outer membrane by putting my hand in it.

It's so unlucky, why did you encounter the rare abdominal cocoon syndrome? Chen Ying bit the bullet and cut open the skin, entering the abdomen layer by layer.

My hand fell on the gray-white tough, thick and hard fibrous outer membrane, and I tried to peel it off.

"Fuck! What the hell is this?!" Chen Yan cursed the moment his hand touched the outer membrane of the fiber. (Note)

Professor Lei stood opposite Director Chen, his hands were numb, as if he had been struck by lightning on his head, and his whole body was burnt on the outside and tender on the inside.

This,

Really

That is,

legendary,

Abdominal cocoon? !

The gray-white, tough and thick fibrous outer membrane is the cocoon.

There is relatively little research on abdominal cocoonism in the medical community because this type of disease is a rare disease.

The clinical manifestations are different, and the understanding is also inconsistent. It has been reported as "small intestinal cocoon syndrome, congenital small intestinal confinement syndrome, small intestinal stage fibrous encapsulation syndrome, intracapsular adhesive intestinal obstruction" and so on.

How could he be so unlucky that a "good" intestinal obstruction turned into abdominal cocoon syndrome?

How do you peel off such thick fibrous tissue?

Professor Lei glanced at Luo Hao, who was standing behind Director Chen, full of resentment.

Every witch who predicts bad omens should be burned!

It's all him!

If he hadn't been beeping all the time, the patient would definitely not have abdominal cocoon syndrome.

Professor Lei complained in his heart like a resentful woman.

After Chen Yan cursed, he felt better. He didn't resent Luo Hao, but like Professor Lei, his hands and feet felt numb.

He vaguely saw a large section of intestine wrapped under a gray-white, tough and thick fibrous outer membrane, separated, ruptured, sutured, and mended...

Even the intestines need to be removed.

Director Chen felt quite aggrieved.

It was bad luck to meet such a complicated patient in the middle of the night.

What I just thought of are all good, and they are the "smoothest" results. I can get off the operating table with stitches and repairs, be discharged from the hospital smoothly, and have a good life.

As for whether patients will have habitual intestinal adhesion or intestinal obstruction after surgery, that is another topic.

But even so, it is a luxury hope.

Chen Yan knew that there was a high probability that he would not be able to perform this surgery.

What if you really can’t do it yourself?

Who can the province look for to rescue Taiwan?

The level of gastrointestinal directors who were second and third year medical students was similar to mine, and they could not perform surgeries that they themselves could not perform.

Looking at the gray-white tough and thick fiber membrane, Chen Yan fell into deep thought.

There is another option - give in now.

For on-off surgery, let the patient's family take the patient to a higher-level hospital - for example... the Union Medical College that Luo Hao just mentioned.

"It's okay. We rarely treat intestinal obstruction. We usually send patients from the emergency department for intestinal obstruction that nearby cities don't dare to open."

What Luo Hao said just now was like a slap in the face, hitting Chen Yan's face, which made all the whiskers on his face lose their energy and hang down limply.

When did a first-year medical college become a small local hospital? !

But if you really have to do it, what should you do if you can't take it off and the patient dies on the table?

If not done, the patient will already have symptoms of neurogenic shock and will most likely not be able to withstand the disease.

Even if the 120 ambulance is flying, it won't work.

Time seemed to stand still, and Chen Yan's hand fell on the gray-white, tough, thick fibrous outer membrane in a daze.

Only the clock hanging on the lintel was ticking, as if urging death.

"Teacher Chen, it seems that you really have abdominal cocoon syndrome."

A voice broke the silence.

It's Luo Hao.

Chen Yan frowned and cursed in his heart.

You don’t have to say it!

Anyone with long eyes can see it.

"Teacher Chen, I have collected 9 cases. Can I help you with this operation?" Luo Hao asked, he seemed a little shy, "If the operation is not performed, it will not be good for the data to appear in the article. "

Chen Yan's heart moved.

"Are you qualified to practice gastrointestinal surgery?"

"Yes." Luo Hao confirmed this.

"Then come." Chen Yan said, looking up at Professor Lei.

Professor Lei turned around and stepped down as if he was being amnesty, without any regrets.

As for things like embarrassment, Professor Lei didn't even think about it.

Director Chen is so righteous. If he turned around and stepped down from the stage, throwing himself on the operating table, he would probably not have any room to cry.

Some directors are willing to pass the blame. Director Chen is a man and would never do such a stupid thing.

Luo Hao brushed his hands and took the stage.

Standing in Isuke's position, he stretched out his hand and said, "Tweezers."

The instrument nurse was startled for a moment, then casually slapped the forceps into Luo Hao's hand.

Luo Hao originally looked at the gray-white tough and thick fibrous outer membrane, but his hands tightened and he felt something was wrong, "I want toothless tweezers."

"..."

The instrument nurse panicked and hurriedly found the toothless tweezers and patted them in Luo Hao's hand.

When the operation encountered difficulties, she could tell that Director Chen Yan was on the verge of going berserk and could throw the hemostatic forceps in his hand and hit her face at any time.

It is best not to do anything wrong at this time.

"Ordinary curved round head comprehensive tissue scissors."

"What?"

Luo Hao glanced innocently at the equipment nurse.

Because there are abbreviations for instruments in operating rooms everywhere, I was afraid that she wouldn't understand, so I told her the full name. Unexpectedly, the instrument nurse became even more confused.

"Bend round scissors." Chen Yan said in a deep voice.

"Oh oh oh."

"Don't worry, the operation is not that difficult. Besides, Teacher Chen is still here, so it's okay if I can't take it off." Luo Hao comforted.

Gan!

When did he become the surgeon? !

Chen Yan looked up at Luo Hao.

Luo Hao looked down at the surgery area with a serious expression.

The expression exposed between the mask and hat was serious, and the only thing he didn't have was timidity.

as if……

As if victory is within reach.

Who gave him the confidence? Chen Yan was confused.

……

……

Note: About 10 years ago, I encountered a patient with a lung rupture about 7 or 8 cm deep. There was no pneumothorax at all on the preoperative film, which was typical of traumatic wet lung.

I always felt that something was wrong that day, so I called the director three times to come in for internal fixation of the rib fracture.

When I opened it and saw it for the first time, the director cursed me like this.

Anyone who looks at it will be numb.

(End of this chapter)