Because the family members and the patient themselves reported that they had no history of close contact, they could not do the most appropriate vaginal B-ultrasound. Zheng Ren could only do an abdominal B-ultrasound.
Although it's a little worse, Zheng Ren has a system like this.
It's just that Zheng Ren couldn't believe the diagnosis given by Big Pig Hotter this time.
Accessory spleen torsion…
This diagnosis... If the patient had pain in his upper abdomen, Zheng Ren would probably believe it immediately. The patient had lower abdominal pain, so Zheng Ren cautiously prepared himself for a B-ultrasound examination.
There were no abnormalities in the uterus and bilateral ovaries, but a mass about 5 inches in diameter could be seen next to the left ovary.
It seems that the disagreement lies here.
Zheng Ren holds the B-ultrasound probe in his right hand and presses the patient's abdomen with his left hand.
When pressing, Zheng Ren noticed that the mass was separated from the ovary, and several large blood vessels could be seen inside.
Zheng Ren agreed with the doctor in the B-ultrasound room, although the physical examination looked like an ectopic pregnancy.
"Where are the family members?" Zheng Ren asked.
An anxious middle-aged woman stood next to her and asked hurriedly: "Doctor, how is my daughter?"
"The origin of the tumor is unknown and requires surgical exploration." Although Zheng Ren had made up his mind, he still cautiously described it in broader terms, "Be prepared for hospitalization and surgery."
The middle-aged woman sweated immediately.
Most people are not afraid when they hear that surgery is required.
Jokes about patients dying after appendicectomy are widely circulated among everyone. Although the chance is very low, it makes people feel afraid of surgery.
"Mr. Zheng, call me during the operation and I'll go take a look." The general manager of the gynecology department was very happy to see that the emergency department took on this difficult job.
But she was quite interested in the diagnosis. She didn't think her diagnosis was wrong, but what the B-ultrasound doctor said made sense, so she was ready to see what happened.
Under normal circumstances, doctors hate surgeries such as laparotomy and thoracotomy.
Because after opening it, no one knows what is inside.
It requires extensive clinical and surgical experience to resolve certain unexpected symptoms.
If you are not careful, the consequences are unpredictable.
Therefore, the gynecology hospital did not insist on it. Anyway, it was an exploration. If a disease such as ectopic pregnancy was found, it would be done directly.
She followed, not only to see what happened, but also because she was afraid that Zheng Ren had no experience in performing ectopic pregnancy surgery.
Now Zheng Ren has a high reputation in the gynecology department because of the medical incident. Although the resident general of the gynecology department disagrees with some of Zheng Ren's diagnoses, he still wants to help him get the truth.
Zheng Ren didn't care and nodded.
Zhong Min from the internal medicine department was on duty today. As Zheng Ren walked, he notified Yang Lei to come over for surgery, and then asked Chu Yanzhi to come over.
He didn't know how the two sisters of the Chu family were arranged, so he could just call him any one he wanted.
Take the patient to the emergency ward for preoperative preparation.
Zhong Min is responsible for picking up patients, asking about medical history, and writing various written materials. Zheng Ren took the time to give pre-operative instructions to the patient’s family.
Regardless of the diagnosis, it is an emergency, and time is precious.
The patient's mother wiped away tears while signing her name on the surgery consent form.
After signing this side, the nurse has already placed a gastric tube and a urinary tube.
Yang Lei's home was a bit far away, so Zheng Ren and the patient's family directly pushed the patient to the operating room.
When he was sent to the operating room, Chu Yanzhi had already arrived. Several people worked together to move the patient to the operating table, and Zheng Ren went to change clothes.
The pre-operative preparation took ten minutes anyway, because the anesthesia procedure was relatively complicated, so Zheng Ren was not particularly anxious.
Vice spleen? Zheng Ren kept thinking about the diagnosis given by the system.
According to tissue culture, accessory spleen is caused by the failure of fusion of the spleen primordium located in the dorsal mesogastric during the 5th week of embryonic life.
Clinical diagnosis is difficult.
On CT scan, the accessory spleen is generally a mass with smooth edges and uniform enhancement of less than 2 cm. MRI scan shows a feeding artery originating from the splenic artery entering the accessory spleen.
B-ultrasound can only be used as an auxiliary, and cannot find the branches of the splenic artery feeding blood vessels like the MRI scan, and cannot enter the tissue that may be the accessory spleen.
Because the patient is an emergency patient, he does not have the time or conditions to complete various examinations. Therefore, the only solution was to choose exploratory laparotomy.
After Zheng Ren changed into his isolation gown, he called the medical office and asked his colleagues in the pathology department to come and work overtime.
If you have accessory spleen in the upper abdomen, this is not necessary.
But it occurs in the pelvis, very far away, and there is a possibility of tumors.
If you want to rule out that the tumor is a tumor tissue and is fed by a branch of the splenic artery, only pathological diagnosis can be confirmed.
Zheng Ren has already explained this in detail to the patient's mother.
And because of this possibility, Zheng Ren was unable to undergo laparoscopic surgery.
Because the small hole of laparoscopic surgery cannot remove the accessory spleen. If it is broken into pieces and taken out, once it is tumor tissue, a large number of implants and metastases will occur, causing the tumor to directly enter the advanced stage.
After everything was considered carefully, Zheng Ren came out of the dressing room, made a call to the gynecology resident, and began to brush his hands in preparation for the operation.
Chu Yanzhi was bouncing around, the patient had been anesthetized, and she was chatting with Xie Yiren.
In fact, it was a chat, but she was mainly talking. Xie Yiren was busy preparing surgical tools while agreeing in agreement.
She asked Xie Yiren where he went and why he didn't go home. She didn't notice the awkward silence between Xie Yiren and Zheng Ren at all.
The girl with thick lines is completely opposite to Chu Yanran.
I don't know if it's because the identical twins have all their delicate thoughts on Chu Yanran's side.
Yang Lei hadn't arrived yet, and Zheng Ren didn't wait for him. After washing his hands, he directly disinfected, laid out sterile sheets, and prepared to open the table.
It's not a big deal to do the surgery alone. Zheng Ren has long been used to it.
The shadowless lamp was bright, and Zheng Ren took a look at the surgical area. Considering the age of the patient, he still hesitated, and finally made an incision on the left side of the rectus abdominis near the middle and lower abdomen, about 8cm long.
The incision is a bit long because the source of blood vessels needs to be explored during the operation.
If the opening is too small, it will be extended during the operation.
The skin is incised and the subcutaneous tissue and fat are bluntly separated all the way to the peritoneum.
The patient is relatively young and the fat layer is not thick, so the surgery is easy to perform.
At this time, the gynecology resident always came over.
Seeing Zheng Ren performing surgery alone, she asked, "Mr. Zheng, can I go on stage?"
"No, Yang Lei will be here soon." Zheng Ren covered the membrane for protection and directly opened the abdominal cavity.
Seeing that the abdominal cavity was opened, the gynecology resident stopped talking and concentrated on watching the operation.
The large retractor pulled apart the skin and muscle tissue of the lower abdomen. Zheng Renhe, a gynecology resident, found the source of the patient's lower abdominal pain, a dark red soft tissue next to the ovary.
However, the dark red is a little darker and a little black.