Doctor: I Can Synthesize Infinite Entries

Chapter 114: Chapter 112: Rare Early-Stage Cholangiocarcinoma, Misdiagnosed as Gallbladder Perforation with a Liver Abscess

Wu Ting followed Ling Ling into the conference room.

Inside the conference room, Director Shen Guofeng, Director Shen Xiaofei, and Yan Xi had been waiting for some time.

"Wu Ting, this is the director of the emergency department, Professor Shen Guofeng. This is the director of the general surgery department, Director Shen Xiaofei. And this is Professor Shen’s student, Dr. Yan Xi."

Ling Ling had been to Jinggang University Affiliated First Hospital for an exchange program before, so she was very familiar with Professor Shen, Director Shen, and Yan Xi.

Just as Ling Ling finished her introductions and was about to introduce Wu Ting to the two directors and Yan Xi, Shen Guofeng stood up and said with some surprise:

"What are you doing here?"

"Professor Shen!"

Wu Ting hadn’t expected it to be Professor Shen either, and his voice was full of familiar warmth.

"I came with Professor Ma to participate in this expert consultation. I’m here to learn and broaden my horizons."

"So you’re the young doctor Professor Ma mentioned? When did you take on another research project?"

Shen Guofeng was thoroughly surprised and delighted.

Yan Xi was also dumbfounded. ’Wu Ting’s progress is just too fast!’

Ling Ling was also very surprised. "Professor Shen, you and Dr. Wu already know each other."

"Haha, that’s right. Dr. Wu is an old acquaintance of mine. I just didn’t expect this rascal to be invited by Professor Ma."

"Come, come, Wu Ting, Ling Ling, please have a seat."

Shen Guofeng was very happy to see Wu Ting.

Yan Xi immediately distributed the patient’s case files to Wu Ting and Ling Ling.

A moment later, Professor Ma Mengchao also arrived in the conference room.

"Apologies, apologies. I was just talking with Dean Song for a bit."

After Professor Ma took his seat, he was about to introduce Wu Ting to Professor Shen:

"Professor Shen, this is Wu Ting from Fan City First Hospital. He’s the talented young man I wanted to recommend to you."

However, before Professor Ma could finish his introduction, Ling Ling interjected from the side:

"Professor Ma, Dr. Wu and Professor Shen already know each other."

Professor Ma was taken aback for a moment, but on second thought, it made sense. "That’s true. A talent like Dr. Wu is bound to shine wherever he goes."

It was the first time Director Shen Xiaofei had met Wu Ting. He was quite impressed that this young man was held in such high regard by both Shen Guofeng and Ma Mengchao.

"Then let’s begin discussing the patient’s condition."

Professor Ma took the patient’s file from Yan Xi and began to read it.

Yan Xi displayed the patient’s latest physical examination results on the screen:

"Complete blood count... Liver function... Serum amylase..."

"Yesterday’s contrast-enhanced MRI+MRCP showed: a large intrahepatic lesion, 6.0 cm x 4.8 cm, communicating with the gallbladder; cholecystitis and gallstones; extrahepatic bile duct dilation, signs of cholangitis; changes consistent with pancreatitis..."

"Hepatobiliary, pancreatic, and splenic color Doppler ultrasound showed: gallstones; a 0.77 cm discontinuity in the anterior gallbladder wall; a 6.7 cm x 3.3 cm intrahepatic lesion continuous with the site of rupture, suggesting a liver abscess from a perforated gallbladder, and gallstones..."

...

Looking at the patient’s latest test results, the directors all frowned.

Shen Guofeng was the first to speak:

"Currently, the preliminary diagnosis is a liver abscess from a perforated gallbladder... We have given the patient symptomatic treatment, including anti-inflammatory, acid-suppressing, enzyme-inhibiting, and fluid replacement therapies, but the effect has not been significant. The condition shows signs of worsening, so timely surgery is still necessary. However, a specific surgical plan has not yet been determined."

"We invited Professor Ma here today to help us formulate the best possible plan."

Shen Xiaofei added:

"Based on the current diagnosis, a perforated gallbladder combined with a liver abscess is very rare clinically. Due to gangrenous cholecystitis, the gallbladder wall was compressed, leading to local ischemic necrosis. Now, an encapsulated empyema has formed around the gallbladder, combined with inflammation and necrosis of the liver parenchyma. These clinical manifestations are atypical, making diagnosis and treatment very difficult."

"Furthermore, the patient is currently experiencing bile leakage. Their skin and sclera show signs of yellowing, and their bilirubin levels are abnormally high. We are also considering obstructive jaundice caused by intrahepatic bile duct dilation."

"In short, the patient’s condition is both complex and unpredictable. The overall situation is extremely dangerous. If we cannot devise a proper plan, it could be fatal. Even if the surgery is successful, a postoperative recovery is difficult to guarantee."

Shen Xiaofei clearly felt how difficult this case was.

After looking over the file for a while, Professor Ma also conceded:

"Correct. The most important thing right now is to first resolve the patient’s obstructive jaundice. We need to perform biliary drainage to excrete the bile."

"However, the patient’s entire gallbladder is perforated, and there is abscess and necrosis in the liver. Conventional drugs will only increase the burden on the liver. We need a gentler, more sustainable approach."

"Moreover, based on the patient’s current condition, it’s not just a simple case of gallstones and gallbladder perforation. There might be a deeper underlying cause! It’s just... I don’t have a definitive conclusion yet..."

Professor Ma Mengchao had noticed a clue, but it still needed to be verified.

Wu Ting had originally planned to just be an observer—his main goal was to acquire a new entry—but when he heard Professor Ma’s words, inspiration struck!

But looking at the patient’s condition—obstructive jaundice, the need for biliary drainage to expel bile—he immediately thought of the entry combination he had collected not long ago.

[System, recommended synthesized entry: PTCD Technique (Yellow) + Yinchen Lidan Soup (Yellow) + Cholangiocarcinoma Diagnostic Technique (Purple) = PTCD combined with Yinchen Lidan Soup for the treatment of cholangiocarcinoma complicated by obstructive jaundice (Purple). A unique and brand-new adjuvant therapy for cholangiocarcinoma, capable of providing better liver function recovery, improving clinical symptoms, and enhancing treatment efficacy compared to conventional plans.]

After the entry was synthesized, a stream of information flowed into his mind, and Wu Ting suddenly had a clear train of thought.

Under the influence of the Cholangiocarcinoma Diagnostic Technique (Purple), Wu Ting also discovered a few issues.

Cholangiocarcinoma is a common clinical malignancy, but most patients do not present with typical symptoms. The tumor exhibits infiltrative growth, so the early diagnosis rate is low. By the time most patients are diagnosed, bile flow has already been obstructed, causing jaundice in the skin and eyes, along with abnormally high bilirubin levels.

Early-stage cholangiocarcinoma is already extremely difficult to diagnose. Compounding this, the patient also had a perforated gallbladder, leading to obstructive jaundice. Due to multiple episodes over many years, each treated conservatively without ever fully healing, this current liver abscess was triggered.

Therefore, what appeared on the surface to be a rare case of a liver abscess caused by a perforated gallbladder was, in reality, early-stage cholangiocarcinoma complicated by gallstones. Due to a lack of timely treatment, perforation and gangrene occurred, which in turn triggered the liver abscess!

If they simply treated it as a gallbladder perforation, they would only be treating the symptoms, not the root cause. It’s very likely that the next time the patient had an episode, it would be late-stage cholangiocarcinoma, and then not even a god could save him!

After thinking it through and analyzing the situation, Wu Ting couldn’t help but feel impressed. ’As expected of entries dropped from Professor Ma and the various directors at the General Surgery Annual Meeting. This diagnostic ability is just too incredible.’

While the two professors and the senior director were lost in thought, Wu Ting raised his hand:

"Professor Ma, Professor Shen, Director Shen, I have a supplementary point to add!"

Seeing Wu Ting speak up, both professors looked over, and Director Shen Xiaofei was also a bit surprised.

Yan Xi and Ling Ling were even more astonished by Wu Ting’s action. ’At a time like this, aren’t junior doctors supposed to just serve tea, listen respectfully, and take notes? Why is he actually starting to participate in the consultation?’

"Dr. Wu, if you have a different line of thought, please share it." Shen Guofeng was very familiar with Wu Ting. He knew the young man’s style—daring to speak and daring to act—and it was one of the things he admired about him.

Professor Ma also appreciated Wu Ting’s sharp drive and listened attentively, never considering denying him the chance to speak just because of his junior status and limited experience.

"At yesterday’s General Surgery Annual Meeting, I listened to Professor Ma’s lecture, ’Reflections on the Minimally Invasive Treatment of Cholangiocarcinoma.’ Afterwards, I also looked up and read quite a few journal articles on cholangiocarcinoma."

"If we exclude some of the confounding symptoms, is it possible that the patient has early-stage cholangiocarcinoma complicated by gallstones? The gallstones have been treated conservatively for over a decade, without much attention paid to them and without timely surgery, which led to the gallbladder perforation, gangrene, and ultimately, the liver abscess."

"Look, the patient exhibits all the early symptoms of cholangiocarcinoma: jaundice, yellowing of the sclera and skin, clay-colored stools, and also has poor bile drainage..."

"And on the imaging studies, although there is interference from the liver abscess, stones, and gangrene, you can still see an abnormality at the site of the biliary obstruction..."

"I suggest we perform a pathological biopsy on the patient!"

Wu Ting’s meticulous, step-by-step reasoning and judgment made Professor Ma and Shen Guofeng feel as if a fog had been lifted.

Prompted by Wu Ting, Professor Ma also began to work backward through the logic and quickly reached the same conclusion.

"I think Wu Ting’s diagnosis is highly probable."

"If it really is cholangiocarcinoma, and we treat it as a perforated gallbladder with a liver abscess, the consequences would be unimaginable."

"Let’s do this: run a serum tumor marker test at the same time—the CA19-9 tumor marker. If it’s truly a biliary tract tumor, CA19-9 will be significantly elevated..."

"Yan Xi, go arrange it immediately!"

Shen Guofeng couldn’t help but admire Wu Ting’s sharp clinical intuition!

Professor Ma’s estimation of Wu Ting also rose even higher!