Inner Mongolia, Horqin Right Center Banner.
The Department of Gastroenterology of a Class A hospital is conducting a hospital-wide consultation.
The director, deputy director, and chief resident of the relevant departments were sitting in the office, looking through the patient's medical records and films in boredom, but no one spoke.
The deputy chief of the medical department who presided over the hospital-wide consultation glanced at everyone, then at the time, and said: "Then let's stop here."
"Section Chief, would you like to..."
"The patient's diagnosis is clear. He is in the advanced stage of liver cirrhosis. We can only recommend that the patient go to a higher-level hospital for treatment. In our hospital..." As he said, he glanced at the silent doctors and shook his head.
Then, he stood up and the deputy chief of the medical department announced that the meeting was adjourned.
The interventional doctor sat in the corner, dejected.
He does not think that the patient cannot be treated, but he cannot cure it himself.
He had severe ascites, his limbs were as thin as firewood, and he looked like a four-legged spider. He was lying on the bed and couldn't even breathe smoothly.
Listening to the patient's breathing sound like a windbox, the interventionalist felt that his airway was beginning to spasm.
He really wanted to learn from the surgeon in the live surgery room, but he knew that this was just an unrealistic idea.
He lowered his head and left the gastroenterology department with some sigh. What seems to be an incurable disease in this second-grade hospital in Horqin may be just a common disease in the live surgery room.
While thinking about all kinds of miscellaneous thoughts, he walked back to his department.
Just as I was thinking about it, the sound of the 120 ambulance rang on my phone.
He immediately became energetic, as if he had been injected with adrenaline intravenously.
I quickly ran to the duty room, took out the pad from the locker, and then walked to a small room as quickly as possible, turned on my phone and pad, and started watching the live broadcast of the surgery.
Somehow, the interventionalist felt that today's live broadcast was very important to him.
The pad played a live broadcast of the patient's surgery, and he used his mobile phone to view the patient's information.
When these words fell into his eyes, he was stunned.
My hunch was right!
Spider-Man! Boot sign! These symptoms fit perfectly!
It turned out to be Budd-Chiari syndrome, not late-stage liver cirrhosis and refractory ascites!
His hands shook slightly, but then quieted down.
The surgeon in the live surgery room has already started the operation.
The camera machine had been returned, and a feeling of regret rose from the bottom of my heart. But he didn't have time to regret or think about possibilities like what if.
Watching the live broadcast of the surgery on the pad with all his concentration, he tried to remember every detail with his memory, which had already begun to decline due to his age.
Although he also knew that this was impossible, he always had to do something.
The guidewire enters the inferior vena cava, wrong! The interventionalist was startled. The guide wire looked wrong in shape!
It's familiar, but it doesn't look right.
Could it be... The interventionalist had a guess in his mind, but the surgeon in the surgical live broadcast room did not explain it from the beginning, and he would not make an exception this time just because he could not understand.
Countless thoughts gathered and swirled in the interventionalist's mind, turning into a huge whirlpool.
The surgeon is not using a micro guidewire, but the most common guidewire, but the shape is a little weird... It seems to have fallen over...
When the guidewire entered the inferior vena cava, it ignored the numerous venous branches and reached the position where the contrast agent was blocked.
The interventionalist's right wrist moved slightly like a marionette.
He didn't even realize that he moved his wrist, it was a subconscious movement. Subconsciously, when the guide wire reaches this position, the problem should be solved next.
The interventionalist didn't know what the problem was. He just felt that the inferior vena cava was blocked by something unknown, which was the source of the problem.
Sure enough, the weird-shaped guidewire moved slightly and penetrated directly through the blockage.
Open the inferior vena cava
Immediately, the stent was advanced along the guide wire.
The stent was opened, angiography was performed, and the inferior vena cava was completely patent.
After the operation is over, the live broadcast room is closed.
So simple... The interventionalist sighed inwardly, but then, an electric current circulated throughout his body.
This surgery, such a simple surgery, can be done by oneself!
Looking back on the "Spider Man" who was hospitalized in the Department of Gastroenterology, the interventionalist seemed to have some enlightenment.
He began looking for information on Budd-Chiari syndrome.
As for the surgery in the live broadcast room? For such a simple surgery, even if you want to forget it, there is nothing to forget.
It means opening, removing the stent, angiography, and the operation is over.
It is simply simpler than appendicitis, by a geometric order of magnitude!
If you can do it yourself, you can definitely do it!
The interventionalist realized with excitement. But he immediately suppressed his excitement, calmed down, and began to search for various literature on Budd-Chiari syndrome.
He knew that if he saw others struggling to carry the burden, he would be tired of carrying the burden himself.
The tips surgery is extremely simple and can be completed with just one puncture. But after many days of research, the interventionalist finally gave up.
Surgery videos alone are absolutely not enough.
He could not grasp the key point of how the surgeon judged where to pierce.
I hope that the interventional surgical treatment of Budd-Chiari syndrome will never have such an easily overlooked but crucial point!
After searching and pondering for several hours, the interventionalist walked around the small storage room excitedly.
The library of the Second Class A Hospital in Horqin Right Wing Middle Banner, Inner Mongolia did not have any information, so he searched for it on the provincial library network.
There is not much information in the provincial map, but I found two documents about Budd-Chiari syndrome.
Comparing each other and overlapping the surgeon's surgical experience with the gastroenterology patients, the interventionalist thinks he can do it!
It’s just a very simple operation!
Sometimes, it is just a layer of window paper. Once it is pierced, there is no secret left.
This was the case with tuberculosis more than a hundred years ago. Twenty years ago, without interventional surgery, Budd-Chiari syndrome was an incurable disease. Even if surgery is performed, the mortality rate is extremely high if there is a problem with the location of the second porta hepatis.
And the condition... is also quite simple. There is a membrane-like substance growing in the inferior vena cava, which is open at first and gradually closes as we age.
This closure is physiological, not pathological.
When the inferior vena cava is completely closed in youth, venous blood return is blocked, and venous return can only be completed through collateral circulation.
So, everything can be explained.
This is not ascites caused by portal hypertension in the late stage of cirrhosis, but ascites caused by inferior vena cava occlusion!
And it can be cured after interventional treatment!
The interventionalist was so excited that he virtualized the surgery countless times in his mind, without any difficulty!
Go to the Department of Gastroenterology, find the director, and the patient’s family.
The interventionalist printed out the information he found and went to the Department of Gastroenterology with confidence.