Surgical artist

Chapter 477 Scalp tingling
"Then Dean Zhao... shall we leave later?" Ren Jinhong saw that the patient's condition had stabilized, so she invited her.She looked at the time, and it was almost time to get off work.

In her opinion, the situation of this kind of hematemesis patient is not serious. As long as the bleeding can be stopped and the examination is done slowly, the root cause of the disease must be the one mentioned by Zhao Peiru just now.

As long as you find out where the bleeding is, symptomatic hemostasis and treatment will do.

Zhao Peiru shook his head slightly: "Let's wait for the patient's examination results first."

"it is good."

Ren Jinhong and Lei Rong waited beside Zhao Peiru.

The two of them didn't know what Zhao Peiru was going to do, but the boss' words were orders.But Lei Rong was moved. Zhao Peiru asked him to help find a case of colon cancer with rare symptoms. Could it be this case?

But he himself couldn't help shaking his head in his heart.

The symptoms of a large amount of hematemesis are obviously only symptoms of the upper gastrointestinal tract, and the cause is generally caused by problems with the esophagus and stomach.How can it be related to colon cancer?
Several people waited for a while.

Soon, one by one, the news will be summarized.

"The results of the B-ultrasound and blood tests came out. The patient did not have liver cirrhosis, and it was not a reaction to non-steroidal anti-inflammatory drugs."

"CT results, there is no external gastrointestinal tumor."

"The results of the gastroscopy came out, and the patient's esophagus and stomach are fine."

As the results came out one by one, Ren Jinhong was dumbfounded.

None of these questions?Where is the bleeding point?

All the causes mentioned just now have been ruled out.A symptom of vomiting a lot of blood, there is no problem with the esophagus and stomach?
Even the people in the emergency department felt a little dizzy, so what caused the massive vomiting of blood?If the bleeding point has not been found, if the patient vomits blood several times...

Now this visual inspection has already vomited 2000CC of blood.You know, ordinary people donate only 400cc of blood and are not allowed to donate.If it exceeds 800, people may go into coma and shock.The patient has already vomited 2000CC of blood, and it is not bad if he is not unconscious yet.

If you can't find out the reason, vomit blood two more times... When the blood pressure drops, it is a sign of dying.

Next to him, Lei Rong looked at Zhao Peiru in shock.A thought kept popping up in his mind, could this patient really be colon cancer?And Zhao Peiru actually saw it early in the morning, and was waiting here?
Are his eyes better than a CT machine?
No, it's not that the eyes are easy to use, but that Zhao Peiru relied on his rich experience and knowledge, and deduced the result through a little bit of clues.It's just that it's too early to say all this, and there is no medical imaging to support this.

"Dean Zhao, what do you think is the situation?" Lei Rong took the initiative to ask.

Director Ren Jinhong and many people in the emergency department all came over curiously.

Now, the root causes that can directly cause massive upper gastrointestinal bleeding have been ruled out, what else could be the cause?
Zhao Peiru said: "Right now, there are two possibilities, one is acute tube-cardia mucosal tear, and the other is colon cancer."

Everyone was stunned.

Acute tube-cardia mucosal tear is well understood. This part also belongs to the upper gastrointestinal tract, which is in the middle of the esophagus and stomach. A tear here will cause a large amount of blood to surge up.

But what about colon cancer?

Colon cancer is the lower gastrointestinal tract, if there is blood, it will flow out through excrement, right?That is what is commonly referred to as blood in the stool.

How can it reverse the colon, jejunum, ileum, duodenum, stomach, cardia and esophagus, and finally spit it out from the mouth in reverse?

Zhao Peiru was expressionless and didn't say much, but said directly: "Take the patient for an enhanced CT, focusing on the colon."

The people in the emergency department hurriedly took the patient for a new round of examinations.

The rest, all with doubts, whispered to each other.But they all felt that their status was low, and they didn't dare to come over and ask Zhao Peiru directly.

Here, Lei Rong's thoughts kept turning, and he couldn't help but ask at this moment: "Dean Zhao, why is this possible to be colon cancer?"

Ren Jinhong also looked over curiously.

She has seen too many patients with massive vomiting of blood. Basically, the causes are all in the upper gastrointestinal tract, either the esophagus, the cardia, or the stomach.This is rarely the case even with cirrhosis.

The cause is colon cancer?Unheard of.

Zhao Peiru said: "Some colon cancers, in particular, can metastasize to surrounding organs such as the stomach, spleen, and pancreas, causing compression of blood vessels. The compression of blood vessels will cause massive bleeding and vomiting."

Ren Jinhong was slightly taken aback when she heard this, what a terrible colon cancer must it be to spread pressure to the stomach, spleen, and surrounding pancreas?

At this moment, she still felt a little unbelievable.After all, compared to such a special and rare colon cancer, she still prefers to believe that there is a problem with the cardia.

Everything, just waiting for the results of enhanced CT.

Finally, the results of enhanced CT came out: local intestinal wall thickening in the splenic region of the descending colon, tumor with surrounding infiltration, involvement of the left renal vein and splenic vein with opening of collateral vessels around the splenic hilum, around the stomach, and inferior abdominal wall, and multiple low-density tumors in the spleen kitchen!

In short, this is what Zhao Peiru said, special colon cancer!

As soon as the result came out, Ren Jinhong looked at Zhao Peiru in shock.

It turned out that Dean Zhao really hit the mark!
If it weren't for Zhao Peiru, they probably wouldn't think that enhanced CT should be used to do the colon, and they wouldn't have found the colon cancer. She probably would have been looking for problems in the upper gastrointestinal tract.

"Dean Zhao, your words saved a life."

Ren Jinhong admired again, and smiled wryly again: "I was wrong."

"Your vision of diagnosis is too high. Fortunately, you are here today. Otherwise, the patient's condition will not know how long it will be delayed."

Most cancers are curable if detected early.Like this patient with colon cancer.

As long as a laparoscopic resection is performed to remove the cancerous lesions, the patient will be safe and sound.

But if it develops late, when the cancer spreads and invades and becomes irreversible, then it really can only wait for death.

The people in the emergency department also looked at Zhao Peiru with incomparable admiration.

Sure enough, he is a boss at the committee level, and he can see the root cause of the patient's illness at a glance!Such a rare symptom can be seen at a glance.

Director Lei Rong next to him was equally astonished. The level of Director Zhao was much higher than when he first saw it!

At that time, Zhao Peiru was ingenious in terms of treatment and surgery, and his ideas were amazing and unconstrained!But now what Zhao Peiru showed was a masterly vision.

Zhao Peiru said to Ren Jinhong: "This patient needs immediate laparoscopic abdominal exploration. I am very interested in this case. Can I take the initiative to apply for this operation?"

Ren Jinhong didn't dare to say: "Dean Zhao, you are joking."

Didn't Zhao Peiru do this surgery as he wanted?

Moreover, it is a great thing that such a big man is willing to undergo surgery on his own initiative!The rest of them will be lucky enough to observe this big guy's on-site surgery.

Lei Rong was also overjoyed. He hadn't seen Zhao Peiru's on-site surgery for a long time, and he still couldn't get enough of the previous on-site surgery.

……

The people in the emergency department went outside to explain the situation to the family members, issued a notice of critical illness, and asked them to sign the consent form for the operation.

The family members were still guessing and asked the doctor: "Is it because he has been too busy recently, worked hard, was too tired and didn't sleep well, so he vomited blood?"

The doctor rolled his eyes silently in his heart, and explained: "The amount of vomiting blood is so large, how could it be caused by fatigue?"

"We just had an enhanced CT scan. We found a tumor in the descending colon that infiltrated the surrounding organs and tissues, as well as low-density shadows. It is very likely to be cancer, and surgical exploration is now necessary."

When the family members heard this, they panicked.

In the impression of many people, cancer is a terrible thing. It is a terminal disease with almost no choice. If you get infected, it means that you will not live well for a few years.

The bodies of several family members suddenly trembled like chaff.

The doctor said: "Our preliminary diagnosis is that even if it is cancer, it is still an early cancer. Fortunately, it was discovered early. If it is delayed for another year or two, it will be really late."

This sentence made the family members' brains turn again.

"Doctor, please treat me quickly. We will sign everything, and we will pay the deposit immediately. No matter how much it costs, the disease must be cured as soon as possible."

As soon as the family members heard that the operation could be cured sooner, they could not wait to race against time, so that the doctor could go back to the operating room to perform the operation right now, without delaying a second.

After the doctor left, the family members finally reacted.

"Fortunately, I came to Ditan Hospital and found out that the root cause of the disease is colon cancer. If this drags on for a few more years..."

Several family members trembled in their hearts and dared not think about it.

"If I still go to the previous lower-level hospital, I will definitely say 'peptic ulcer' again and fool us back."

Several family members are deeply convinced.

"Sure enough, if you are sick, you still have to go to a big hospital to find out the problem earlier. It won't delay the illness!"

……

Emergency department operating room.

In the observation room, apart from Ren Jinhong, Lei Rong, and the emergency department, even the doctors in the gastroenterology department were called down by Ren Jinhong.

This is the boss who came to the scene. It is a rare opportunity to observe and study. Everyone screamed to change shifts with others. They wanted to come down to observe, but the shifted shifts were not happy, and they almost quarreled. It was Ren Jinhong who came forward as a department director Only then did the crowds of scramblers stop.

On the operating table, the patient was intubated under general anesthesia.

Although it is a colon cancer operation in the lower abdomen, endotracheal intubation is still necessary, which can prevent the patient from suffocating due to choking of throat secretions, and save trouble for the already complicated operation.

"Set the pneumoperitoneum pressure, 12 to 15 mmHg."

As soon as Zhao Peiru spoke, the two assistants, the director and the deputy director of the emergency department, immediately carried it out.

As one of the top hospitals in the country, Ditan Hospital has extremely rich experience and high level to be the director and deputy director of the emergency department here.If it is placed in any provincial hospital in Jiangnan Province, it can be at the level of vice president.

Next, Zhao Peiru chose 10 cm above the navel as the puncture point of the observation hole, and inserted a laparoscope to fully expose the pelvic cavity.

In the colonic splenic region, a tumor was observed, 5X5 cm, which clearly invaded the hilum of the spleen, the posterior wall of the stomach, the tail of the pancreas, and the beginning of the jejunum.

"Gudong."

Director Ren Jinhong, who was observing from above, swallowed involuntarily.

Seeing such a visibly invading tumor, she immediately understood what Zhao Peiru said.

"Dean Zhao is really accurate. This colonic lesion has invaded such a large area! No wonder it compresses the blood vessels and causes the patient to vomit blood. Fortunately, it doesn't seem to be infiltrating, and the cancer cells haven't spread, but..."

There was a hint of worry in her eyes: "But it also brought a great test to the operation."

Such a serious malignant tumor can be said to be a cancerous "big tree", and the thin "branches" with luxuriant branches and intertwined branches are very difficult to remove!
It is equivalent to peeling off an irregular tumor from the flesh and blood tissue it wraps bit by bit.

If a little bit of cancer cells are not treated properly during the peeling, and are scattered and missed in the patient's body, it is tantamount to planting the seeds of cancer cells, and one day the patient will have cancer again.

"Even if such a complex tumor is removed by laparotomy, it is difficult to control it directly by hand under direct vision. However, Dean Zhao chose the more difficult laparoscopic resection..."

Using a laparoscope to incision means that there are two instruments between the hand and the tumor, like "relieving the itching through the boots", with no tactile sensation and no operational feedback.

Ren Jinhong and the others felt both admiration and worry in their hearts.

Obviously, since Zhao Peiru can see that this is a special case of colon cancer, he must know how difficult it is to cut this "irregular cancerous lesion".But Zhao Peiru still insisted on choosing the laparoscopic surgery that is more patient-friendly. This is for the sake of the patient, and he also has confidence in his own technology.

Just when everyone thought that Zhao Peiru was going to start cutting and separating.

The scene that suddenly appeared within the field of view of the laparoscope made everyone's heart skip a beat!
"Look at another perspective."

"This malignant tumor not only invaded the surrounding tissues, but also invaded the renal vein behind the pancreas, the renal capsule, and the abdominal aorta..."

This scene made everyone's scalps go numb!

The scope of this irregular tumor's invasion far exceeded everyone's imagination!

"It's no wonder the patient vomits a lot of blood. It turns out that the tumor compresses the blood vessels so severely!"

It was the first time for many of them to see such a serious tumor invasion!

"This... must have a laparotomy, right?"

Such a severe and complex irregular tumor is very difficult to remove.

This must be converted into a surgical operation!

Everyone looked at Zhao Peiru, waiting for him to make a decision.

Zhao Peiru seemed to have known about this situation for a long time.

He continued to operate the laparoscope calmly, explored the edge of the tumor bit by bit, and said casually: "There is no need to open the abdomen, laparoscopic resection is enough."

Everyone heard that Zhao Peiru had completed his evaluation and decision, they looked at each other and could only obey.

Facing such a severe situation, Dean Zhao still has the confidence in laparoscopic resection.This confidence... no wonder he became one of the seven committee members!
Under the watchful eyes of everyone, Zhao Peiru used the ultrasonic scalpel to gradually cut off the inferior mesenteric artery and vein, and clean the root lymph nodes.The bilateral hypogastric nerves attached to the surface are exposed.

(End of this chapter)