After a stinking scolding, the room fell silent.

Zhuang Yongzhi and Zheng Qingmu glanced at each other, and the two of them really sensed Dr. Wu's momentum.

Scolding, although vulgar, but Dr. Wu has his own reasons. And he was very strong, just because Dean Sun refused to listen to Dr. Wei's report, Wu Mian did not hesitate to turn his face directly.

"I can imagine that you do your daily rounds to see patients, sit in your office and look at all kinds of test results, look at all kinds of pathological descriptions. Since that's the case, what's the use of you?!" Wu Mian's fingers tapped the table at a faster speed, and the sound of dong dong was like a war drum.

"Nurses write nursing records, that's what nurses write, there is a difference between people's cognition, why don't you take a look at it for yourself?"

Dean Sun didn't know why Wu Mian knew that no one had seen the patient's stool, but what he said was the truth, and Dean Sun was interested and didn't dare to refute it, so he could only bow his head and listen, scolding in his heart.

"Dr. Wei, you go on. Wu Mian said.

Wei Dabao looked at Section Chief Wu's back in a daze, although he knew that he was supporting himself, but ...... Now the fierce scolding, I will say my judgment for a while, and when I am damaged, I am estimated to lose face even more.

There was silence, silence in the room.

Chu Zhixi smiled to break the embarrassment, "Doctor Wei, you boldly said that it's okay." With my brother here, the situation you see has basically determined the condition. ”

"Uh......" Wei Dabao was stunned, could it be that Section Chief Wu thought the same as himself?

"Report the medical history. Wu Mian tapped his fingers on the table, and the sound of a thump pulled Wei Dabao's thoughts back.

"Yes, Section Chief Wu. Wei Dabao said respectfully, "I found a problem, I haven't looked at the previous medical records, and I'm not sure." The patient had diarrhea yesterday morning and had a stool volume of about 2000 L, but it improved in the afternoon. ”

"Yesterday's treatment was a pig's tail...... ureteral stents, and some medications have been replaced. ”

Chu Zhixi then flipped the tablet in front of him and said, "The ureteral stent has been lowered three times, and yesterday was the last one. After each session, the diarrhea improved. ”

"That's because every time I want to get a ureteral stent off, I ask for a global opinion.

"Dr. Wei, continue. Wu Mian said in a deep voice.

"I observed the patient's bowel movements and found that although the stool was formed, there were about 200 liters of watery stool. Wei Dabao said that his biggest gain from observing feces is that it is difficult to explain. ”

As he spoke, Wei Dabao looked at Wu Mian.

"At the beginning of the treatment at the Hong Kong Sanatorium & Hospital, I suspected that it was an infection, and I changed several antibiotics to no avail. Later, after consultation, I found a rheumatology and immunology expert to see that it was suspected to be systemic lupus erythematosus, and gave hormone pulse therapy. Wu Mian seemed to see Wei Dabao's gaze and began to narrate the treatment.

He didn't look at the tablet in front of him, Dean Sun and the other doctors all looked at Wu Mian in surprise, not knowing how this person knew so much. He did flip the tablet a few times just now, but what are you doing with a few clicks?!

"Every time I got a ureteral stent, I had more urine, less kidney failure, and less diarrhea. However, about 3 days is the limit, and then diarrhea will worsen. Wu Mian ignored the other people's gazes, he looked ahead, and said lightly, "Doctor Wei, continue to talk about your judgment." ”

Wei Dabao's heart was reassured, and he could feel Section Chief Wu's encouragement to him.

After steasing his mind, Wei Dabao said, "I suspect that the patient's ureters and intestines are connected. ”

"Boom~~~" There was a sudden uproar in the conference room.

"This can't be!" said a foreign doctor, standing up.

"Radiation injury, which leads to long-term inflammatory irritation, ureteral fistula, although rare, is not impossible. Wu Mian looked at the man with a smile and said, "What evidence do you have that this kind of guess is impossible?"

"The location of the radiation therapy is in the pelvis!"

"That's not the reason. Wu Mian said, "You, sit down." Case discussion, if you want to speak, raise your hand, how did your teacher teach you, and your senior doctor would allow you to be so rude?"

The man was stunned for a moment and muttered, "I'm the senior doctor." ”

"Not anymore, sit down. "Dr. Wei has just put forward his opinion, and the initial diagnosis is ureteral fistula. I'll start by saying a few points about why this is possible, and then let's discuss it. ”

"Radiation enteritis, it's almost certain.

Secondary colon and proctitis often occur within 6~18 months after radiotherapy. Symptoms such as diarrhea, blood in the stool, mucus and tenesmus, thinning of the stool, and progressive constipation, or abdominal pain suggest intestinal stricture.

Severe lesions form fistulas with adjacent organs, such as rectal fistulas, from which stool is discharged, rectal and intestinal fistulas may be mixed with stool and discharged, or peritonitis and abdominal or pelvic abscess may be caused by intestinal perforation. ”

"Sinus tracts in the ureters and intestines are not very likely, but this cannot be ruled out based on the periodic changes in the amount of diarrhea in the patient. ”

"There's one thing in the medical record that I'm sure everyone has noticed. Wu Mian returned to a gentle attitude, and Lang Lang said, "Every time after the ureteral stent, the patient's diarrhea will improve.

Although different doctors consult and develop a treatment plan, each time a ureteral stent is placed under the necessary treatment, followed by a change in medication. We can say that the drug works, but the urine is smooth, the amount of diarrhea is reduced, and this obvious change cannot be ignored. ”

"If, according to Dean Sun, it is the effect of the drug, then there is no way to explain the subsequent changes in the condition. After each ureteral stent, urine output decreases within 2 to 3 days, and diarrhea increases. ”

"Please note that the patient had 5000l of diarrhea per day, and I could not think of any other disease other than cholera that could lead to such serious consequences. ”

"With such a large amount of diarrhea, the patient's serum ion changes are not precipitous. I don't know if any of you have treated cholera patients, but I have experience. "The change in serum ions after a large amount of diarrhea is quite large, but the patient's laboratory results deny this. ”

"Such obvious evidence was ignored by everyone. Wu Mian said, shaking his head.

"Again, three times in a row there was a record of formed feces...... Twice, the third time just observed by Dr. Wei. Wu Mian revised his statement, "It all appeared after the ureteral stent was placed, so we can't rule out the possibility of ureteral fistula." ”

"These days, Hong Kong Sanatorium & Hospital has ruled out a lot of causes. It's hard to believe, but at the end of the day, there is only one diagnosis, no matter how rare it is. ”