Ruan Bin followed Xiaoli to the operating room, and saw that there was a woman in her forties on the operating table at this time.

"What's going on?" asked Ruan Bin as he walked over after getting dressed.

"The director didn't come?" Zhang Haoyu was stunned when he saw that the person who came was Ruan Bin.

"The director is not available, so let Dr. Ruan come and help. Xiaoli explained.

"Oh......" Zhang Haoyu also calmed down a little at the moment, and suddenly remembered that Ruan Bin definitely stood out in the cholecystectomy, maybe the other party had a way to solve it!

"The preoperative examination is different from the current situation after surgery!"

"Previous abdominal ultrasound showed gallbladder dilation, no gallstones, and a 9 mm segmental gallbladder wall thickening. At the time, I thought it was a segmental adenomyomatosis possibility. However, on oblique scanning, there is no dilated dividing area within the gallbladder and the gallbladder wall is not thickened. CT scan of the abdomen with contrast shows diffuse gallbladder dilation and gallbladder wall thickening. ”

"But I have this appearance after laparoscopic exploration now, what the hell is this?" Zhang Haoyu frowned. In other words, his previous guess may have been a misdiagnosis!

Ruan Bin leaned over to take a look and saw that under laparoscopy, gangrene and a dilated gallbladder could be seen attached to the liver, rotating counterclockwise around the cystic duct, and the gallbladder appeared congested and bleeding.

Fibrin is deposited in the muscle layer, but the gallbladder neck and surrounding tissues are normal!

"It should be acute gallbladder torsion!, so it's normal to misdiagnose!" Ruan Bin said. From clinical analysis, gallbladder torsion is first a blood transport disorder, the gallbladder vein is first blocked, and the cystic duct is twisted! Then the disease changes from mild to severe, resulting in gallbladder enlargement and gallbladder wall thickening. And it can cause gallbladder congestion, gangrene, hemorrhage. It can also cause yellow sputum, peritonitis. Due to the sudden onset of gallbladder reversal, there is basically an 82%~100% chance of misdiagnosis!

"It turned out that the gallbladder was reversed, no wonder, I have never seen this kind of case!" Zhang Haoyu looked suddenly enlightened.

"Hehe, don't say it's you, I guess Director Liu hasn't encountered it either! Gallbladder torsion is a rare condition that has only been reported about 500 times in the literature since the discovery of the "floating gallbladder". Gallbladder torsion usually occurs in older women, and emergency surgery is generally recommended. However, only 25% of cases are diagnosed preoperatively. The mechanism of gallbladder torsion remains unclear, but anatomical abnormalities, such as lengthy mesentery and visceral prolapse, are more likely to lead to torsion. Ruan Bin said.

In this case of acute gallbladder torsion, he has world-class experience in cholecystectomy and tens of thousands of surgeries, among all of his surgeries. In the experience of this kind of situation, he could count the operating tables he had encountered on one hand!

Therefore, even if Director Liu comes, he may not have encountered it!

"That'...... How can you do that?" Zhang Haoyu subconsciously estimated that Director Liu had never encountered it, so Ruan Bin definitely hadn't encountered it either, and the two of them were now considered to have met Dacai.

But how do you do this surgery?

"Although this disease is rare, the difficulty of the operation is not very high, and the gallbladder is removed!" Ruan Bin said with a smile. If surgical treatment is not delayed, early cholecystectomy in cases of gallbladder torsion has a mortality rate of 3%. In cases of perforation and biliary peritonitis, the mortality rate is increased and can be higher than 5%.

So he didn't think it was a big problem!

"Then I'm going to go ahead with the gallbladder removal?" Zhang Haoyu asked with a sigh of relief.

"No, you can't start the removal directly, you have to twist and reduce the gallbladder first, otherwise it will hurt the cystic duct and even cause massive bleeding. Ruan Bin shook his head and said.

If cholecystectomy is not reduced, the problem is big.

This is also why he is fortunate to come and take a look, otherwise Zhang Haoyu will definitely have something to do like this.

"That'...... This reset ......" Zhang Haoyu was a little flustered.

"I'll reset it, I'll take over this operation later." Ruan Bin said with a smile. Reduction must be done carefully, otherwise the cystic duct will be injured or even ruptured.

Moreover, there are many edema adhesions in the neck of the gallbladder torsion, and it is a little difficult to dissect, so the laparoscopic surgery must be operated by a doctor with high proficiency to avoid injury to the cystic duct.

Next, Ruan Bin carefully operated, first slowly reducing the gallbladder, and then began to remove the gallbladder.

With a world-class level, he naturally has no problem operating.

Ten minutes later, it's done!

............

Walking out of the operating room, Zhang Haoyu said with a smile: "This surgical example, we think it can be uploaded to the doctor's forum, and show countless colleagues this rare surgical example." ”

"Haha...... This can be had. Ruan Bin smiled and nodded.

"Then I can apply to Director Liu. ”

"I don't care~"

At this moment, suddenly there was a quarrel in the lobby of the emergency department, which was heard by the doctors, nurses and patients of the entire emergency department.

A lot of people are watching!

"What's going on?" Ruan Bin and Zhang Haoyu walked over.

I saw a middle-aged man in his thirties holding an eight or nine-year-old boy, the boy's eyes were red at the moment, and his face was still a little frightened.

There was also a well-dressed couple on the side.

At this time, it was this middle-aged man who was arguing with the couple!

"The surname is Dong, if my son has three longs and two shorts, I want you to look good!" Meng Dalong said with tears in his eyes. His son was bitten by the dog of Dong Tianjie and his wife opposite!

"If you are bitten by a dog and can't die, didn't we promise to pay for your son's medical expenses? Let me tell you, my Samoyed dog was bought for 80,000 yuan. You just killed my dog, and I want you to pay double compensation! Do you know how many years it has been with me? Three years, three whole years! I raised him like a son!" Ding Lili screamed.

"You guys, you are so shameless! Is it your fault that you are at fault in the first place, and you still want me to compensate? Is it that you walk your dog without pulling the leash, and your dog bites my son and doesn't let go, if I don't kill it, I don't know what it will bite my son into! If your dog doesn't stop it when it bites my son, you still want me to compensate?" Meng Dalong roared angrily.

"I don't care! Anyway, if you kill my dog, you have to compensate!" Ding Lili said disdainfully.

"That's it, you have to accompany you!" Dong Tianjie of course supported his wife.

At this time, there are more and more onlookers.

The words of this shameless couple made this honest Meng Dalong almost burst his lungs: "Friends, you are commenting on reason, are they still reasonable? It is their fault in the first place!"

"That's right, it's just that if you walk the dog yourself and don't guard it, you have to compensate the dead dog if you bite someone else, and it's still not a person!" said a middle-aged aunt with disdain.

"What dead dog, dead dog? Don't you know that dogs are good companions of human beings? Dogs' lives are not fatal? Do you know that humans and dogs are equal?" Ding Lili immediately disagreed.