Luo Hao was also very helpless.

Abdominal callouse is relatively rare, and Professor Lui's misdiagnosis is not a problem, but his attitude is very problematic.

How can it be as if he jumped into a well with his child in his arms, isn't it just a diagnosis, Luo Hao can't figure it out.

"You suggest? What's your last name? Professor Lei sprayed directly, irritable.

Luo Hao's expression was like a carving, and he didn't change at all, "Teacher Lei, you ......"

"What am I! What subject are you? Come and give us gastrointestinal advice! ”

Professor Lei stood on the commanding heights of the hospital department system and opened fire, and Luo Hao was also helpless.

Although the system does not issue a task, you can see the patient yourself, and you can't let it go.

In fact, Professor Lei's diagnosis cannot be said to be wrong.

Abdominal callouse is also a type of intestinal obstruction.

It is a rare, unexplained specific type of intestinal obstruction.

It was first reported and named by Foo in 1978.

Diagnosis is often difficult due to a lack of clinical awareness, and the prognosis is generally poor.

If you want to treat abdominal calluses, intubation and decompression are useless, just a waste of time.

Of course, Luo Hao can do what he can do, and "brush" the amount of surgery, which is the easiest.

But there is no unnecessary surgery, Luo Hao will definitely not do it, this is the most basic principle problem.

"Teacher Lei, listen to my explanation." Luo Hao said gently.

"Explain? What is your explanation? You don't even have the qualifications for interventional consultation, what are you going to eat when you come to our gastrointestinal surgery! ”

Professor Lei seized the qualifications and output.

Luo Hao shrugged, spread his hands, and looked at the sky.

"Are you sure, Professor Lei?" Luo Hao's smile faded a little, and he asked gently.

"I'm really not sure about your, you bite me if you have the ability!" Professor Lei glared at Luo Hao viciously, then turned around and went back to the duty room.

Professor Ray held his breath.

There is no hair on the mouth, and the work is not firm.

The kid named Luo Hao gave him face and asked him to do the operation, but he actually started to point fingers at the diagnosis.

Damn it!

……

When Luo Hao saw Professor Lei returning to the duty room, he also turned around and took out his mobile phone.

"Teacher Chen, it's me, Luo Hao."

Luo Haoxian concisely reported the patient's situation.

"Corey's diagnosis is fine, it is indeed intestinal obstruction, but I think it is a very rare abdominal callopathy in intestinal obstruction. Mr. Chen, in the past few years, I have collected some information on cocoon syndrome and am preparing to publish a paper. ”

Luo Hao spoke very quickly, and did not give Chen Yan a chance to react at all, and directly proposed the matter of the paper.

There was a brief silence on the other end of the phone.

"Xiao Luo, the paper on cocoonism? Prepare to pitch for a journal with the prefix, it doesn't make much sense. Chen Yan said lightly.

"No, Mr. Chen, there are two projects, one is an analysis of the surgical approach of young women with abdominal callouse, and the other is a case report. Are you interested? The Lancet, first author. ”

"What if you misdiagnose it?"

On the phone, Director Chen Yan's breathing became a little thicker.

"That's my fault, there are no case reports and review papers, and the first author counts me as an apology. There are already 9 cases of patient data accumulation, I have obsessive-compulsive disorder, and I have been trying to make up for 10 cases. ”

"Okay, I'll take a look."

Hanging up the phone, Luo Hao breathed a sigh of relief.

Let's go on stage first, most of the young women with abdominal cocoon disease are physically weak, and the condition is serious in the later stage, with many postoperative complications and a high mortality rate.

It is much better to start the stage early and solve the problem as soon as possible than to delay it for three or five days.

At the very least, the prognosis is much better.

As for the diagnosis, Luo Hao has his own judgment, and the auxiliary diagnosis AI also gives a definitive diagnosis, not to mention that there is no misdiagnosis rate, it should belong to the category of extremely low.

Luo Hao returned to the doctor's office, and the hospitalized always stared at Luo Hao.

"Mr. You, what's wrong?"

"Xiao Luo, I've heard people talk about you, Xiehe left you, you didn't agree?"

You always use a question.

Obviously, he wasn't sure if it was or not.

This "rumor" is too incredible, and Mr. You always feels that it is not true.

How much water is in the brain for this to happen.

"My level is not enough, plus I am homesick, so I will go back to Donglian."

"Huh? It turned out to be true! How many people want to stay in Xiehe can't stay, what are you thinking in your head? ”

Luo Hao smiled and was silent.

Seeing that Luo Hao didn't answer his own question, Mr. You didn't care.

He smiled, "Xiao Luo, the patient is intestinal obstruction, there is no need to be so nervous." The mass is considered to be caused by intestinal gas, in fact, your interventional department is particularly suitable for intubation and decompression. Professor Lei's level is not low, you can see it. ”

"Hmm." Luo Hao responded.

"Abdominal cocoon syndrome, although adolescent women and the like are still considered to be on the side, but after all, it is a rare disease, and it is generally not considered clinically."

"The patient has severe pain and has already developed symptoms of shock."

"No, I can only try it with a laparoscope first." Mr. You said, "Professor Lei's level of single-port laparoscopic release of intestinal obstruction is really high. ”

Luo Hao gave Mr. You a kind smile.

This person has been knocking on the side to persuade himself, and Luo Hao feels that he has good intentions.

"Professor Lei has not had a good temper, especially lately...... Ahem, ahem. Mr. You coughed a few times and didn't continue.

Luo Hao estimated that there were other problems that were inconvenient to tell him.

"If the situation is not right, I can go to surgery at any time, I have already said hello to the operating room, and the emergency desk is open at any time."

"Xiao Luo, Professor Lei usually talks like that, don't be angry. After the operation, you find a time to apologize, and even if this matter is over, Professor Lei will not hold a grudge. ”

"Why don't you try to intubate and exhaust first? It doesn't take long, and I do preoperative preparations, so even if you are right, you won't delay the patient's surgery and treatment. ”

"Mr. You, it's really useless." Luo Hao replied seriously.

Mr. You shook his head with a smile and asked the doctor on duty to write the medical records, and he took his mobile phone to look at something.

After more than ten minutes, Mr. You raised his head, "Xiao Luo, if you don't do it, go back and rest, in the middle of the night, there is no need to stay up here with me." I'll wait half an hour to take a look, and if it doesn't work, I'll call Professor Lei to the stage. ”

"I called Teacher Chen, it should be almost there."

"Teacher Chen?" Mr. You was stunned for a moment, and immediately understood that Luo Hao was calling Director Chen Yan and Chen.

！！！

Mr. You looked at Luo Hao with surprise in his eyes.

He really thinks Director Chen is easy to talk to? A few beautiful words, this kid took it seriously, and he had to "pick" Director Chen from home in the middle of the night.

The ignorant are fearless, he doesn't know that he is not Director Feng Zixuan.

Legend has it that this one seems to have something to do with Dean Kim.

"Xiao Luo, I heard ......"

Mr. You was just about to ask, when footsteps came from the corridor.

"Mr. You!"

Belch...... It was Director Chen's voice.

Mr. You immediately stood up and strode out of the office.

"Director Chen, why are you here?"

"Where's Xiao Luo?"

"Director Chen, I'm here." Luo Hao looked down at Chen Yan.

It's too short...... Luo Hao felt that it was rude to bow his head and wanted to bend his knees and look at him, but in that case, the posture was too strange and deliberate.

Forget it, let's keep your head down, Luo Hao thought to himself.

"Go and see the patient." Chen Yan was not verbose, went straight to change clothes, and then saw the patient.

The pain was severe, and in less than half an hour, blood pressure had begun to fluctuate.

In particular, the patient's pulse pressure difference has narrowed to within 20 mmHg.

paleness, irritability, clammy limbs, cold sweats, rapid heartbeat, strong pulse, unstable blood pressure, high and low pulse pressure, low pulse pressure difference, thirst, and little urine.

This set of symptoms is directed at neurogenic shock.

"Ready to take the stage, what about Professor Lei?" Chen Yan asked solemnly.

"Rest, Director, I've already said hello to the operating room, and I'll be on at any time. The patient was in a good state when he first arrived......"

"Send the patient." Chen Yan turned around, "Xiao Luo, you come with me." Mr. You, call me after the poisoning. ”

"Okay."

Mr. You sent the patient to the operating room, he was a relatively shrewd and capable hospitalist, and he had already prepared for the operation.

Luo Hao and Chen Yan came to the director's office.

"Xiao Luo, you're too good at tossing." Chen Yan sat down, his two little short legs couldn't reach the ground, and he swayed.

"Director Chen, it's really callousing."

"Huh." Chen Yan smiled, his laughter was very cold, his face was full of beard and swords, and his spear and halberd were aimed at Luo Hao.

"Xiao Luo, I know that your endoscopy level is very high, and you may have your own understanding of the gastrointestinal tract, but that is the work of the endoscopy room and the gastroenterology department, and it has nothing to do with my gastrointestinal surgery."

Luo Hao was silent, smiling, and listening quietly.

"Patients are considered to be intestinal obstruction, and rare abdominal callouses are not considered. Even if it's callousing, what can you do? ”

"In the provincial city, I am the only one who can do abdominal cocoons!"

Luo Hao was suddenly interested.

"Mr. Chen, how many cases have you done? Are there any medical records? ”

"I don't lack articles, what do good clinicians do in scientific research, what we have to do is to lead the team, do surgery, treat diseases and save people."

Chen Yan said solemnly.

His every word was very harsh, and he whipped Luo Hao like a whip.

"Oh, that's a pity." Luo Hao didn't seem to hear the thorn in Chen Yan's words, and said regretfully.

"You came from Concord, and you have seen a lot of incurable diseases." Chen Yan stared at Luo Hao, "But not all diseases are considered incurable, and soldiers are impermanent, water is impermanent, and there is still an option for surgical approaches for abdominal calluses?" Are you kidding. ”

Although Chen Yan didn't point his nose like Professor Lei to tell Luo Hao to get out, he reprimanded him with a fierce voice.

Luo Hao didn't speak, just listened.

In less than twenty minutes, Chen Yan's mobile phone rang.

"Let's go, go to surgery." Chen Yan jumped down from the chair and said coldly, "Xiao Luo, I suggest you don't be clever, "The Lancet" can be sent if you want?" Also the first author, this little favor can't move me. ”

"I'm here to see Director Feng's face, otherwise if you come to the first hospital of our medical university on the first day, directly rejecting your idea may not be conducive to your future development."

Luo Hao was still silent, and followed Chen Yan to the operating room to change clothes.

As for Chen Yan's bragging, Luo Hao didn't take it to heart.

The first author of "The Lancet" still belongs to Xiao En Xiaohui? Replaced by Mr. You, he can let him knock on himself.

The operating room of the First Hospital of the Medical University is located on the 3rd floor, adjacent to the intensive care unit, blood bank, emergency laboratory department, and supply room.

At first glance, the overall layout and planning show that it is a new building that will be around 5-10 years old.

After entering the emergency room, Mr. You and Professor Lei were preparing the laparoscopic equipment.

The itinerant nurse moved three footstools and placed them in the corner, ready for Director Chen to come on stage.

Chen Yan stood in the way with his hands behind his back, not saying a word.

"Director, I've made a single hole." Professor Lei glanced at Luo Hao.

"Well, let's go in with a single hole." Chen Yan responded for a moment, and then said to Luo Hao, "Xiao Luo, you can't do intestinal obstruction with that laparoscope, right, it's basically an open abdomen?" ”

"It's okay, we rarely do intestinal obstruction, and we are generally sent from the intestinal obstruction emergency department that the nearby cities dare not open. There is laparoscopy, and there is also an open abdomen, depending on the situation. ”

？？？

Chen Yan was talking about the general mine of Donglian City, but Luo Hao replied about Xiehe.

Damn, you can pretend!

Chen Yan scolded in his heart.

"However, laparoscopy is done very little, and most patients need to open their abdomen. The patient's intestinal wall is thin and brittle, and the laparoscope is prone to collateral injury. ”

Luo Hao said softly.

Chen Yan's beard was completely wrapped in a mask, and he had to wear an N95 for surgery.

But after listening to Luo Hao's words, N95 has been pierced with hundreds of holes, leaking air everywhere.

"Heh, if you can't do it, you can't do it, it's not a concordance." Professor Lei said disdainfully, "No matter how good Concord is, why don't you stay there?" Is this flying to save Taiwan? Rescue the table of intestinal obstruction? ”

"Let's go." Although Chen Yan was in his heart, he still interrupted Professor Lei's nagging.

Feng Zixuan's attitude towards Luo Hao Chen Yan saw it in his eyes, and he knew the importance in his heart.

It would be of no benefit to him to offend a young man like Luo Hao for no reason.

So Chen Yan was ready to slap his face with facts, so that Luo Hao would retreat from the difficulty, and don't point fingers again.

Seeing that the operation had begun, Chen Yan walked forward with his hands behind his back and came behind Professor Lei.

"Director." The itinerant nurse carries the footstool to the most suitable position.

Chen Yan stood on the footstool, and he just happened to be able to see the screen between Professor Lei and Mr. You.

"Huh?"

When the camera went in, Chen Yan sighed.

In the field of vision, a piece of white flowers, and the familiar local tissue structure of the intestine cannot be seen.

"What is this?" Professor Lei was also stunned when he saw this scene.

Chen Yan didn't speak, and quietly watched Professor Lei scan the surgical area with difficulty with a mirror.

A layer of gray-white tough and hard fiber outer membrane like a wall, wrapping the intestines, and nothing can be seen under the camera, only a gray patch.

In a few minutes, Professor Lei's surgical gown was soaked with sweat.

He had never seen such a situation, and he didn't dare to move.

Who knows how thick the gray-white layer of tough and hard fibrous outer membrane is, and who knows how thin the intestinal wall beneath the fibrous wrap.

If the intestinal wall of the tongs goes down and it leaks by itself, and the roast duck cover is all drained into the stomach, then it's fucked up.

After a few seconds of trance, Professor Lei turned his head curtly, "Director, ...... you look?"

It was perfect for him to feel that the director was taking the blame for him, and that troubled boy was not useless.

"Turn your abdomen, you can explain it to the patient's family."

"Confess, Director." Mr. You replied immediately.

Director Chen turned around and got off the footstool to brush his hands.

The surgical procedure was changed from laparoscopy to laparotomy.

Fortunately, there was only one eye before, and it was still in the position of the navel eye, which did not affect anything.

Chen Yan brushed his hands, disinfected, put on clothes, and wore gloves, the three footstools had already been set up, and he climbed the stairs and stretched out his hand while standing on the footstool.

The scalpel slapped in his hand.

Chen Yan hesitated and made a 15cm incision.

This incision is a bit long, but Chen Yan just saw a layer of gray-white tough and hard fiber outer membrane through the lens, and his heart was a little empty.

Talking to Luo Hao before that if the patient has abdominal callouse, only he can do it in the province is bragging, Chen Yan doesn't think Luo Hao has a chance to expose himself.

But when he saw the gray-white tough and hard fiber outer membrane, he regretted it a little.

At this moment, Chen Yan was a little troubled.

Hopefully, it's just exudate, and the hand can be put in to peel off the outer layer of fiber.

It's so unlucky, how did you come across a rare abdominal cocoon? Chen Ying cut the skin hard and entered the abdomen layer by layer.

The hand falls on the grayish-white tough and hard fibrous outer membrane and tries to peel it off.

"! What the hell!! Chen Yan scolded the moment his hand touched the outer membrane of the fiber. (Note)

Professor Lei stood opposite Director Chen, his hands were numb and crispy, as if he had been struck by a thunderbolt on the top of his head, and the whole person was scorched on the outside and tender on the inside.

this

It's true

It is

Legendary,

Abdominal calloonism?!

The gray-white tough and hard fiber outer membrane is the cocoon.

There is relatively little research in the medical community on abdominal callouse because this type of disease is a rare disease.

The clinical manifestations are different, and the understanding is also inconsistent, and it has been reported successively as "small intestinal cocoon encapsulation, congenital small intestinal confinement syndrome, small intestinal staged fibrous encapsulation, intracapsular adhesive intestinal obstruction", etc.

Why is it so unlucky, a "good end" intestinal obstruction turned into a cocoon.

How do you peel off such a thick fibrous tissue?

Professor Lei glanced at Luo Hao, who was standing behind Director Chen, with resentment.

Every witch who predicts bad omen should be burned to death!

It's all him!

If he hadn't been beeping, the patient would never have had a cocoon.

Professor Ray scolded in his heart like a resentful woman.

After Chen Yan scolded, the whole person was not good, he did not resent Luo Hao, but like Professor Lei, he felt numb in his hands and feet.

He vaguely saw a large section of the intestine wrapped under the grayish-white tough and hard fibrous outer membrane, separating, rupturing, suturing, suturing and repairing......

Even the intestines have to be removed.

Director Chen felt quite aggrieved.

In the middle of the night, I was unlucky to encounter such a complicated patient.

The ones I just thought about are all good, and they are the result of "the smoothest", and they can get off the operating table with sewing and mending, and they can be discharged from the hospital smoothly and get up.

As for whether the patient will have habitual intestinal adhesions and intestinal obstruction after surgery, that is another topic.

But even so, it is a luxury.

Chen Yan knew in his heart that there was a high probability that he would not be able to take this operation.

What if I can't do it myself?

Who in the province to save Taiwan?

The level of gastrointestinal directors in the second and third years of medical college is similar to that of themselves, and they can't do the surgeries they can't do by themselves.

Looking at the gray-white tough and hard fiber outer membrane, Chen Yan fell into deep thought.

There is another option - admit it now.

Doing a switch surgery to have the patient's family take the patient to a higher level hospital – for example...... Luo Haogang said about Concord.

"It's okay, we rarely do intestinal obstruction, and we usually send it from the intestinal obstruction emergency department that the nearby cities dare not open."

What Luo Hao said just now was like a slap in the face, slapping Chen Yan's face, making his face full of beard lose his spirit, and hang down softly.

When will the first year of medicine be considered a small local hospital?!

But if you really do it hard, if you can't take it down, what should you do if the patient dies?

If you don't do it, the patient has already shown signs of neurogenic shock, and there is a high probability that you will not be able to resist the imperial capital.

Even if the 120 ambulance flies, it won't work.

Time seemed to stand still, and Chen Yan's hand fell on the gray-white tough and hard fiber outer membrane in a daze.

Only the clock hanging on the lintel ticked, as if urging life.

"Teacher Chen, it seems that it is really a cocoon syndrome."

A voice broke the silence.

It's Luo Hao.

Chen Yan frowned and scolded in his heart.

You still need to say it!

You can see with long eyes.

"Mr. Chen, I have collected 9 cases, can I give you a hand in this operation?" Luo Hao asked, he seemed a little shy, "If you don't have surgery, the data will appear in the article, which is not good after all." ”

Chen Yan's heart moved.

"Are you qualified to practice gastrointestinal surgery?"

"Yes." Luo Hao affirmed this.

"Then you come." Chen Yan said, looking up at Professor Lei.

Professor Lei turned around and stepped down as if he had been amnesty, without any nostalgia.

As for things like losing face, Professor Lei didn't even think about it.

Director Chen is righteous, if he turns around and leaves the stage and throws himself on the operating table, he is afraid that he will have no place to cry.

Some directors are willing to dump the pot, but Director Chen is a man and has never done such a dog thing.

Luo Hao brushed his hands on stage.

Standing in Ichisuke's position, he stretched out his hand, "Tweezers." ”

The instrument nurse was stunned for a moment, and casually slapped the tweezers in Luo Hao's hand.

Luo Hao originally looked at the gray-white tough and hard fiber outer membrane, his hand tightened, and he felt wrong, "I want toothless tweezers." ”

“……”

The instrument nurse panicked, and hurriedly found the toothless tweezers and slapped them in Luo Hao's hand.

When the operation encountered a problem, she could detect that Director Chen Yan and Chen were on the verge of going berserk, and she could throw out the hemostat in her hand and smash it on her face anytime and anywhere.

At this time, it is best not to do the wrong thing.

"Ordinary curved round head comprehensive tissue scissors."

"What?"

Luo Hao glanced at the instrument nurse innocently.

Because there are abbreviations for instruments in operating rooms everywhere, I was afraid that she would not understand, so I said the full name, but I didn't expect the instrument nurse to be even more confused.

"Rounded scissors." Chen Yan said in a deep voice.

"Oooh."

"Don't worry, the surgery is not that hard. Besides, with Teacher Chen in charge, it's okay if I can't take it down. Luo Hao comforted.

Gan!

When did he let him take the knife?!

Chen Yan looked up at Luo Hao.

Luo Hao's expression was serious, and he looked down at the operation area.

The expression between the mask and the hat is serious, and the only thing that is not there is timidity.

Seems......

It's as if the odds are in place.

Who gave him self-confidence? Chen Yan was puzzled.

……

……

Note: It was about 10 years and I met a patient with a ruptured lung about 7 or 8 cm deep. The preoperative film showed no pneumothorax at all, typical of traumatic wet lungs.

That day, I always felt that something was wrong, so I called the director three times to "Xu" to do internal fixation of rib fractures.

The first time I opened it, the director cursed like this.

Whoever looks, everyone is numb.

(End of chapter)