Doctor: It's reasonable to perform surgery on yourself.

To put it bluntly, the patient has a problem but doesn’t know what’s wrong.

"Where's the body temperature?"

Xu Qiu found the latest body temperature measurement results.

38.1 degrees Celsius.

fever?

Xu Qiu's eyes lit up.

Perhaps the twitching of the limbs is not epilepsy, but causes related mental symptoms?

Fever + mental symptoms, it is likely to be meningitis!

Yes or no, a lumbar puncture will make it clear.

However, Xu Qiu did not judge further and continued to look at other inspection reports.

There are many abnormal items in the blood routine.

For example, the white blood cell count is 21 units, which is significantly increased; the red blood cell count is only 4 units, and the corresponding hemoglobin is about 80, showing moderate anemia.

Platelets, etc. are within the normal range.

The good news is that the patient's cardiac color ultrasound, D-dimer and other indicators did not exceed the standard, which at least proved that there was no big problem with Pang Honggu's heart.

However, liver and kidney function is not good.

Her alanine aminotransferase was almost five times that of normal people, her aspartate aminotransferase was also much higher, and her creatinine and uric acid levels were all seriously exceeded.

In addition, potassium 3L, glycated hemoglobin 5.28%, high-sensitivity C-reactive protein 2.69 mg/L, fasting blood glucose 8.25 mmol/L...

Imaging examination.

B-ultrasound showed no enlargement of the gallbladder and dilation of the hepatic bile duct and pancreatic duct.

Basically, cholecystitis, biliary tract infection, pancreatitis, etc. can be ruled out.

Needless to say, myocardial enzyme test and electrocardiogram are no problem.

In addition, a supplementary abdominal CT can rule out intestinal obstruction, acute gastrointestinal perforation, etc.

The most important thing is to rule out acute gastrointestinal perforation.

This means that the patient will not die immediately.

"Is it really meningitis?"

All inspection results were clear.

The good news is that there are anomalies, big and small, across all kinds of indicators.

The desperate bad news is that these abnormal items are too confusing to indicate a meaningful disease.

There is no problem with the head, the heart, and the abdomen. Could it be an ordinary acute appendicitis?

Xu Qiu could only put a question mark temporarily.

The plan for now is to treat the appendicitis.

After all, acute appendicitis hangs over the patient's head, and acute gastrointestinal perforation may occur at any time. When it reaches this stage, it will be too late to have an operation.

Xu Qiu didn't think that an old man with so many underlying diseases and two huge wounds on his abdomen and sacrococcyx could survive an acute gastrointestinal perforation.

This surgery was finally arranged for Shi Lian.

After signing the contract that night, Shi Lian went on stage and performed an emergency laparoscopic appendectomy.

This surgery is not difficult. For people like Pang Honggu who are old and have poor physical conditions, what is more difficult is actually the anesthesiologist.

It is necessary to ensure the effect of anesthesia and reduce the impact of drugs on the body.

There are also high blood pressure that needs to be controlled, diabetes that needs to be managed, and abdominal pain that needs to be suppressed...

At around seven o'clock, the anesthesiologist turned over the patient with a grimace.

Laparoscopy successfully entered the abdominal cavity

Shi Lian also recorded everything during the operation.

“There is no obvious purulent effusion in the pelvic cavity, the appendix is ​​in the anterior position, and there is no pus covering it…

"The appendix is ​​about 0.6*7cm, and no gangrene or perforation is found. Exploration shows that the right peritoneum is equivalent to the level of the mid-axillary line and back, and there is a large area of ​​retroperitoneal blood stasis from the diaphragm to the pelvic segment. There is no rupture, and there is no active bleeding into the abdominal cavity. Exploration of the colon and transverse colon’s hepatic flexure showed no perforation, the liver was red in color, had sharp edges, the liver quality was uniform, there were no nodular changes, and there was no obvious enlargement of the gallbladder…”

Just when he was about to cut it off, Shi Lian was suddenly startled.

She looked intently at the screen. Under laparoscopy, there was a large amount of pus in the patient's body.

A lot!

"No, it's unreasonable!"

Shi Lian immediately became alert.

That’s not to say that appendicitis doesn’t produce large amounts of pus.

As long as there is a perforation, let alone a large amount, the entire retroperitoneum may be filled with blood and pus.

But the problem is, Pang Honggu doesn’t have a piercing!

This means that a large amount of pus is unlikely to appear in the patient's body.

Unless...there is another source that I haven't noticed!

Shi Lian quickly checked.

Soon, she discovered more abnormalities.

The patient's inflammation was very mild, and there was almost no trace of edema in the abdominal cavity. Logically speaking, the symptoms of appendicitis should be very mild, but the fact is exactly the opposite.

"Quickly, contact the teacher!" Shi Lian was sure something was wrong this time.

She also had a guess in her mind.

If he guessed correctly, only Xu Qiu could handle it... If it had been anyone else, Pang Honggu might not even be able to step down!

"What's going on!" The anesthesiologist who was dozing off immediately woke up.

Shi Lian whispered: "Retroperitoneal hematoma has formed, I think it is a ruptured abdominal aortic dissection!"

"How is it possible? There is no prompt on the CT scan!"

"There are always things that are missed...it is not bleeding due to rupture of abdominal aortic dissection. There is no way to explain the hematoma in the retroperitoneum and the amount of pus of this magnitude!"

Everyone on the field suddenly stopped talking, and the atmosphere became tense.

Soon, Xu Qiu, who was resting in the office, rushed to the operating room.

After looking at the field of surgery that Shi Lian had opened, Xu Qiu's eyes became serious.

He had a premonition that this patient had a lot of doubts, so he did not go home for Shi Lian's surgery tonight, but stayed in the hospital.

I didn’t expect something would really happen.

After quickly taking a look at the situation, Xu Qiu nodded and said, "You are right."

It was a ruptured and bleeding abdominal aortic dissection.

At this time, he looked back at the patient's blood routine report and realized that he had overlooked something.

For example, white blood cells.

The patient's white blood cells have reached 21 units. When the index reaches this level, the appendix is ​​often swollen, and there is a high probability of diffuse inflammatory exudate around it, and the probability of gangrene and perforation is very high!

In other words, for this kind of patient, let alone an accurate abdominal CT, even a B-ultrasound can clearly find an abnormal appendix and find the surrounding abscesses.

However, in fact, although the patient's CT suggests appendix, it is not too serious.

After laparoscopic surgery, the results are very consistent with the images, and the patient's appendicitis is indeed not very serious.

It was not until this time that the results finally became clear.

The so-called abdominal pain of the patient was not appendicitis at all, but abdominal aortic dissection.

Even the abdominal CT did not find it. Xu Qiu guessed that it was most likely a dissection of the small iliac blood vessels, and the rupture should also be a small blood vessel, and it was ruptured before and after the operation.

Otherwise, the patient would not have survived until now.

"Go talk to the family and prepare for artificial blood vessel replacement." Xu Qiu said.

Shi Lian immediately replied: "Teacher, before you came, I had already sent someone to talk, and the family has signed!"

Xu Qiu showed an approving look.

Although Shi Lian could not handle such an acute and severe disease, his judgment of the condition has become more mature.

After all, artificial replacement after abdominal aortic dissection rupture and bleeding is a level 4 operation, and ordinary tertiary hospitals are not willing to accept it, and they cannot be too demanding of this twenty-year-old girl.

While preparing for blood vessel replacement, Xu Qiu still had a question in his mind.

During the exploration, the patient's liver and kidneys were fine.

So, where did the abnormal liver and kidney function come from?

——

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