Famous Among Top Surgeons in the 90s
Chapter 521 - Chapter 521 【521】Preoperative Rapid Assessment

Chapter 521: [(521)] Preoperative Rapid Assessment Chapter 521: [(521)] Preoperative Rapid Assessment This was the first time they had encountered each other since the incident with the envelope drop and Xiao Yazhi’s surgery.

Xie Wanying’s attention was on the patient.

The heart rate was 126 beats per minute; blood pressure was a bit low, suggesting that the intestines might be incarcerated. Xie Wanying speculated.

Soon, Dr. Liu Chengran arrived at the hospital.

“Bring me the CT images,” Dr. Liu Chengran commanded as he walked into the operating room.

All the preoperative patient data was handed over.

Dr. Liu Chengran reviewed the patient’s information and asked Xie Wanying, “Tell me, what’s the situation with this patient?”

Being interrogated by a teacher in an emergency at night was nerve-wracking, but Xie Wanying quickly shared her understanding of the case, “The preliminary diagnosis is Paraduodenal Hernia, PDH. This condition is easily misdiagnosed and overlooked, which is why it wasn’t detected during earlier internal medicine treatments at another hospital when the patient’s symptoms were not pronounced. This time, the patient’s symptoms worsened after vigorous exercise following a full meal and could not be relieved by medication. The family urgently brought the patient to our hospital’s emergency department for help, and after taking a CT scan, there was no particular obstacle to diagnosis. Paraduodenal Hernias are divided into left and right. Based on the result of the CT scan, this patient appears to have a left-sided hernia, with jejunal loops entering the Landzert fossa. On the CT, a cystic intestinal loop can be seen slightly pronounced between the upper abdominal pancreas and the stomach.”

“How do you think this surgery should be performed?” Dr. Liu Chengran continued to question her.

“The patient is showing symptoms of intestinal obstruction, vomiting, and we cannot rule out volvulus or strangulation leading to necrosis. As the endoscope can’t advance, an exploratory laparotomy is required. A midline incision should be made on the abdomen, the intestinal loops inside the hernia sac should be extracted and repositioned, and the hernia ring should be closed. It’s hoped that the intestines haven’t ruptured or turned necrotic, otherwise, it would be peritonitis. Presently, the patient does not seem to show signs of peritonitis, so we must perform the surgery as soon as possible.”

Listening to her quick and composed response, Dr. Liu Chengran decided that Tan Kelin’s orders could be carried out and commanded, “You’ll do it.”

What did the teacher say? It was so sudden that even the students were caught off guard.

Dr. Liu Chengran waved his hand, “Go scrub in, you’re going to be the Chief Surgeon for tonight’s surgery.”

Li Qi’an took a deep breath in disbelief, What?! Didn’t they say that surgical medical students’ first attempt at being Chief Surgeon is supposed to be an appendectomy?

An appendectomy? If an exploratory laparotomy is needed for appendicitis, it’s generally severe diffuse peritonitis, and even our attending doctors might not be able to save such patients. The appendectomies scheduled nowadays are all done laparoscopically, which doesn’t leave room for interns to practice. It’s best for interns to learn traditional open surgeries to build a strong foundation, and then move on to laparoscopic procedures.

Now that such an opportunity has arisen, it’s time for the intern to give it a try. If you miss this shop, there won’t be another.

This surgery isn’t necessarily much harder than the appendectomies formerly used for intern practice. In fact, appendectomy surgery used to be quite difficult, with some interns taking a long time just to locate the appendix once they made the incision. For surgical interns, one of the thresholds is how to quickly locate the diseased area once inside the abdomen. Interns need to develop the mental experience to correlate the radiological images with the actual anatomical locations of the organs inside the patient’s abdomen.

It’s one thing to theorize in your mind, but quite another to execute the procedure. Otherwise, why would it be common to hear seniors say that the juniors are all talk and no action. They can speak eloquently, but everything falls apart when they start working with their hands.

“Haven’t you done this with your Teacher Sun before?” Dr. Liu Chengran said to the student.

Previously, Teacher Xiao Sun had performed a surgery case which coincidentally involved dealing with a Paraduodenal hernia; she was the first assistant and had the good fortune to participate. She did have a clear memory of how the surgical steps should be approached.

“Do it!”