Rebirth in the medical world

Chapter 216 A Murder Case Caused by a Fishbone ([-])

This discovery made him feel very strange. Judging from the patient's medical records, the patient had no history of neck disease, and the degree of internal ulceration was very serious. Could it be an endoscopic injury?
Ouyang Chenhui thought to himself, turned around and asked Zhang Renkuan: "Director Zhang, has the patient had any endoscopic examination recently?"

Zhang Renkuan was very surprised that Ouyang Chenhui would ask such a question. Patients in the respiratory department seldom have endoscopic examinations, only the gastroenterology department does more!But he didn't dare to underestimate Ouyang Chenhui now, so he replied honestly: "The patient has never had an endoscopy, but it is possible to have a gastroscopy next time!" Zhang Renkuan said truthfully, Now he agrees that patients belong to the category of digestive system!

Since no endoscopic examination has been done, how can the patient's neck be damaged so badly?Moreover, through his simple inspection with the naked eye, this injury has been at least ten days old, there is a lot of pus on the wound, and a huge abscess has formed on the neck.It is estimated that the large blood vessels in the neck have been damaged!

The more Ouyang Chenhui looked at it, the more strange it became. The abscess was relatively large. He changed his viewing position several times, and his eyes were always in a state of high tension, but he still didn't see anything special in the deep part of the abscess!

Could it be that the foreign body has damaged the blood vessels and then wandered away in the body?Ouyang Chenhui was suspicious in his heart, staring at one part for a long time, he felt his eyes were a bit astringent, since his eyes could see more subtle cell structures, his eyes became more delicate than before. Impatient with fatigue, I often look at one part continuously for a few minutes, and my eyes will become astringent and I will have a headache and dizziness!
Therefore, he stopped watching at the right time, turned to the patient's bed, and chatted with the patient casually!

At the beginning, in order to relieve the patient's tension, Ouyang Chenhui chatted with the patient about the daily life, learned about the situation at home and his work and life, and after talking for about ten minutes, he felt that the patient had completely relaxed When he got down, he changed the topic and turned to the situation of the patient's admission to the hospital this time!
"Can you tell me if you have had any surgery before, or have you suffered any injuries?" According to Ouyang Chenhui's preliminary judgment, he thinks it is very likely that the patient's previous surgery or trauma did not treat the wound properly. The wound ruptured, causing an internal infection.

"To tell you the truth, I have lived for so many years. I am almost 40 years old this year. This is the first time I have been hospitalized. I am in good health. Not to mention surgery, I have never had a cold or fever for several years! When I was young, my family was poor, and we They were all grown up in free range, and their skin is solid, so they seldom deal with hospitals, and I didn't expect to have such a strange disease this time!" The patient's words were also very anxious.It would be better if I knew what my disease was.

"Then did you feel uncomfortable a few days before you were admitted to the hospital? Or did you have any special physical condition?" Ouyang Chenhui still didn't give up and continued to ask questions.

"Special circumstances? Not really. I'm a rough person. I don't usually pay much attention to my physical condition. We work on construction sites. We usually eat and sleep in the open. If we are hungry and full, it's good to fill our stomachs. How can I have time to care about my own physical condition!" The patient said, feeling a little helpless!
"However, if there's anything special about it, there really was such an incident a few days ago!" The patient was in deep thought, as if he suddenly remembered something, and said slowly.

"What's the situation? Let's hear it!" Ouyang Chenhui was excited. Sometimes, a doctor is like a detective. He needs to understand the patient's situation in detail. Some small things that seem insignificant to the patient may be diseases. The cause of the disease!

"It's been about ten days. I went to eat boiled fish with some workers and drank some wine. When I was about to finish eating, I felt a fishbone stuck in my throat. At that time, I choked on steamed buns. , I drank vinegar again, tossing and tossing for a long time didn't work, I felt uncomfortable in my throat for several days, and then I didn't feel anything in my throat, so I started to have a continuous fever, I stayed at home for a few days, and finally couldn't even breathe I had no choice but to come to the hospital, I didn’t expect it to be so serious, could it be caused by this fishbone?” The patient smiled helplessly after finishing speaking.

What the patient said not only made Ouyang Chenhui's eyes brighten, but even Wang Yi and Zhang Renkuan's faces showed joy!Could it be that the fishbone scratched the digestive tract and caused the infection?
Ouyang Chenhui quickly focused his eyes on the patient's neck again. The patient's abscess was relatively large, and the esophagus and trachea were all enlarged to varying degrees. Looking inside through the abscess, Ouyang Chenhui seemed to faintly see a line about three or four A centimeter-long, S-shaped foreign body was stuck horizontally in the esophagus, one end poked at the esophageal wall, and the other end poked at the aorta. Ouyang Chenhui wanted to take a closer look at the specific position of the fish bone, and felt dizzy for a while. , you can't see anything anymore!

"Director Zhang, hurry up and do a CT scan for the patient to confirm whether the fishbone is stuck in the body!" Wang Yi burst into excitement, and hurriedly said, this Ouyang Chenhui always brings unexpected surprises to everyone at critical moments reward!If this patient is really the cause of the fishbone, Ouyang Chenhui has made a lot of contributions!

"Xiao Su, immediately notify the CT room to do a pre-bed CT, and tell them to hurry up!" Zhang Renkuan hurriedly asked a resident doctor to contact the CT room.

When the CT room heard that patients isolated in the intensive care unit were going to undergo CT, they did not dare to neglect, and immediately sent two doctors to push the CT machine to the intensive care unit of the respiratory department!
After a CT scan, it was found that the blood vessels in the patient's neck were severely festered, obviously due to being stabbed by a foreign object, but due to a long time, the specific location of the fishbone was not found!

However, this is enough to make Zhang Renkuan and Wang Yi excited!This CT report is enough to prove that this patient is not a respiratory system infection. It also means that he can finally be released from isolation and is no longer the focus of attention of the leaders. Zhang Renkuan can also breathe a sigh of relief temporarily!
"Ouyang, you have a unique mind. If this patient is really the result of a fishbone, I will ask for credit for you as soon as Dean Qi comes back!" Wang Yi smiled brightly, and Zhang Renkuan quickly echoed: "That's right. , if the cause of the patient's disease can be diagnosed, Ouyang will be a well-deserved hero. Not only has he solved a big problem for our respiratory department, but he has also saved a lot of money for the hospital! To tell you the truth! I We have already started to prepare to go to Shanghai to invite experts to come for consultation!"

"Haha! Didn't that save a lot of money for the hospital? It seems that Dean Qi is going to treat guests!" Wang Yi was in a good mood, making a rare joke.

"If you want to say that I will make you a full-time member, we don't have the ability, but it's absolutely fine to invite you to dinner. Even if Dean Qi doesn't invite you, I will invite you!" Zhang Renkuan unloaded a big rock at once, feeling relieved Little, the suffocation that had been pent up in his chest for a long time was released at once!There is an indescribable sense of joy all over the body!

Hearing these kind words, Ouyang Chenhui didn't feel much anymore. He is not the kind of person who likes to listen to good words, so he hurriedly interrupted the two doctors' compliments to him in a timely manner.

"Director Zhang, the most urgent task now is to arrange surgery as soon as possible. From the CT scans, I feel that the fishbone is very likely to have punctured the esophagus and aorta, forming an 'esophagoaortic fistula', which is the most serious form of esophageal foreign body. Complications, the survival rate of this disease is very low. In addition, the course of the disease has been more than ten days, it is estimated that this operation will be more difficult!" Ouyang Chenhui said, and the two directors nodded silently.

The places where the digestive tract is most likely to get fishbone stuck are: the oropharynx (the deep mouth where the tonsils are located); the hypopharynx (the bifurcation of the trachea and esophagus); the esophagus (the esophagus is divided into four narrow places: 1. The narrow zone below the hypopharynx 2. The narrow zone where the aorta crosses the esophagus 3. The bifurcation of the left and right trachea crosses the narrow zone where the esophagus crosses 4. The turning mouth where the esophagus enters the abdominal cavity).

If the fishbone is in the oropharynx or throat, it can be taken out with narrow and long forceps; if the fishbone enters the esophagus, it is small and has not punctured the esophagus, it can be taken out with a soft gastroscope; if the fishbone is relatively large and has not punctured the esophagus , take it out with a hard esophagoscope, which can protect the esophagus; if the fishbone has pierced the esophagus, it needs to be taken out through a thoracotomy.

In addition, if the fishbone does not enter the digestive tract but goes to the airway, a bronchoscope can be used to remove the foreign body.

The most dangerous one is what Ouyang Chenhui said. Of the 80 cases reported in China with esophageal foreign body complicated by arterioesophageal fistula, only 3 cases survived.Foreign literature has reported nearly 90 cases, only 2 cases survived.

The atmosphere that had just eased became tense again. If what Ouyang Chenhui said was really an "esophageal-aortic fistula", the operation would indeed be a big challenge for them!

Esophageal foreign bodies puncture the aorta, and the patient's mortality rate is over 80%.Two causes of death -

The foreign body punctures the aorta, causing bleeding and death, but this often happens on the operating table, and improper operation causes the aorta to bleed.In the early days, the fishbone was inserted on the aorta, but it was relatively safe, because the blood vessels dilated and contracted, and the fishbone was clamped by the openings on both sides, so bleeding was unlikely.

In another case, when a fishbone is inserted into the esophagus, the esophagus and aorta will fester over time, and the blood from the aorta will also flow out and flow into the chest cavity, causing various serious infections.Even if the fishbone does not pierce the aorta, the ulceration of the esophagus will cause the adjacent aorta to ulcerate and be fatal.

In the first case, to take out the fishbone, the chest must be opened to fully expose the lesion, and an extracorporeal circulation machine is used to allow the body's blood to flow to other places temporarily instead of the aorta, so that there is no chance of bleeding. If necessary, pull out the fishbone.

A small fishbone can cause such a big disaster, this is really a bloody case caused by a fishbone!

(End of this chapter)