Doctor: I Can Synthesize Infinite Entries

Chapter 97: Chapter 97: Post-operative Review: A Miraculous Diagnosis

Upon arriving at the hospital, Xiao Xixi immediately took the patient for an abdominal ultrasound.

Dong Chen didn’t quite understand what was happening, but watching Wu Ting’s professional demeanor, all he could do was wait anxiously.

While the patient was getting the abdominal ultrasound, Jiang Ming and Huo Yun arrived at the emergency department.

"How’s the patient?"

Huo Yun asked immediately.

"Director Huo, Dr. Wu sent the patient for an abdominal ultrasound."

A nurse immediately answered.

"Wasn’t it supposed to be a myocardial infarction?"

During the earlier phone call, Huo Yun had been told the patient was suffering from an acute myocardial infarction.

"That was the initial diagnosis. But after the patient was in the ambulance, Dr. Wu performed a thorough physical exam, ruled out an acute myocardial infarction, and suspected it was an acute abdomen instead."

"So, right there in the ambulance, Dr. Wu used the simplest materials available to perform an abdominal paracentesis. Just as he suspected, he found biliary ascites."

"The thing is, the patient had a cholecystectomy ten years ago. So, before the ultrasound results came back, no one could figure out what was really wrong, or why he would have biliary ascites."

Hearing the nurse’s explanation, Huo Yun was rather surprised.

Jiang Ming grew pensive. Even with all his experience, he couldn’t guess what the patient’s condition could be. He was even more curious about how Wu Ting had arrived at such a diagnosis.

’To decisively perform an abdominal paracentesis in an ambulance... he must have discovered something during the physical exam.’

As Huo Yun and Jiang Ming waited, the patient’s ultrasound results came in.

Xiao Xixi and Wu Ting brought the patient to the resuscitation room.

Huo Yun and Jiang Ming immediately went to meet them.

"Let me see."

Huo Yun took the ultrasound report, and one look was enough to leave him astonished.

"It’s a rare spontaneous perforation of the common bile duct!"

"It’s a good thing Wu Ting identified the condition. If treatment had been delayed, or if we had treated him for an acute myocardial infarction, the patient would most likely have died."

"Time is critical. We need to perform emergency surgery immediately."

"Jiang Ming, Wu Ting, you’re with me in the operating room. I’ll be the lead surgeon."

Huo Yun’s expression was grim, but he was thankful that Wu Ting had discovered the problem in time.

With Director Huo’s decisive command, the medical staff immediately mobilized.

Dong Chen didn’t understand the specifics of the disease.

But he understood one thing clearly: because he had blindly trusted an online diagnosis and misled the doctors, his father had nearly died from the delay in treatment.

’That was so close. Thank God this Dr. Wu is highly skilled and resolute. Otherwise, I would have swayed his judgment.’

After all, even the veteran Xiao Xixi had almost been led astray by his assumptions.

A wave of fear washed over Dong Chen in retrospect:

’Looks like I can never try to diagnose things myself based on what I read online again. I have to listen to the judgment of professional doctors.’

「Inside the operating room.」

Director Huo was the lead surgeon, with Jiang Ming assisting. Wu Ting, who had only acquired the diagnostic skills but had yet to even begin learning such a difficult common bile duct procedure, could only stand quietly to one side to observe.

Thanks to the diagnosis confirmed by Wu Ting’s abdominal paracentesis and the ultrasound, Huo Yun had a clear direction.

He performed a laparotomy on the patient, and what they saw during the operation was horrifying.

"Wu Ting, we really have you to thank for this one. If we’d been just ten minutes later, the patient likely would have been a goner."

"This patient has a very rare spontaneous perforation of the common bile duct. The situation was already extremely critical."

"Look here. The patient’s porta hepatis has widespread adhesions. There’s biliary effusion between the intestinal walls and within the greater omentum, and it’s especially concentrated around the hepatoduodenal ligament..."

Even the battle-hardened Huo Yun felt his scalp tingle at the sight.

Using a laparoscope, they quickly found the perforation site.

The patient’s common bile duct was 2.5 cm in diameter, with a 0.8 cm by 0.5 cm perforation on the anterior wall. Purulent bile and sand-like stones were spilling out!

Huo Yun pointed to the affected area, discussing it with Jiang Ming. It was clear this operation had significant teaching value. If it was recorded, it could be presented at academic conferences.

"You see? The patient’s common bile duct mucosa is swollen and already showing patchy gangrene... We’re incredibly fortunate Wu Ting discovered it in time."

After confirming the cause, Huo Yun began the procedure. Due to severe contamination in the abdominal cavity, he first performed a thorough irrigation with saline solution, then placed a T-tube at the perforation site and used interrupted sutures to close the common bile duct...

"The patient’s condition is still extremely critical. Attempting a full bile duct repair right now would be counterproductive. So for now, we’ll focus on simple external biliary drainage. Once the patient stabilizes, we can perform a Roux-en-Y choledochojejunostomy..."

After the surgery ended, Director Huo prepared to conduct a debriefing on the case.

As it was a rare case of spontaneous common bile duct perforation, it had immense teaching value. Therefore, Huo Yun invited the director of the Hepatobiliary Surgery Department to join a discussion.

When Cai Qi, the director of Hepatobiliary Surgery, heard about a patient with spontaneous common bile duct perforation who was nearly misdiagnosed with an acute myocardial infarction, he rushed over, intrigued and excited.

Director Cai, Director Huo, Director Jiang, Wu Ting, Qin Donglai, and Song Qi all gathered for a meeting.

After reviewing the patient’s medical history, Director Cai was deeply impressed.

"Director Huo, you truly live up to your reputation as Jin Province’s top gallbladder expert. This patient had his gallbladder removed long ago, showed no clinical signs of jaundice, and his family mentioned a history of coronary heart disease, all of which pointed to an acute MI. To risk the patient dying from a heart attack by performing an abdominal paracentesis—and in an ambulance, no less—is truly admirable."

"Based on the postoperative analysis, it seems that after the common bile duct perforated, bile flowed into the abdominal cavity, which lowered the intraductal pressure. This prevented a mechanical rupture of the ampulla of Vater and stopped bile and bilirubin from refluxing directly into the lymphatics and bloodstream. That’s why there were no signs of jaundice."

"Still, it’s baffling why the patient’s common bile duct would perforate spontaneously in the first place."

The more Director Cai analyzed the case, the more he marveled at Director Huo’s expertise.

’Under those circumstances, even I wouldn’t have been able to make such a decisive call.’

’Spontaneous common bile duct perforation without any signs of jaundice... it’s just far too easy to miss.’

"What a stroke of luck. If he had actually been treated for an acute MI, or managed conservatively without a laparotomy, the patient would have had virtually no chance of survival."

Director Cai also marveled at how perilous the situation had been.

Jiang Ming agreed. It was truly a miracle that the patient had survived.

Huo Yun agreed with Director Cai’s assessment, adding:

"Director Cai, your assessment is correct. To diagnose a biliary tract issue and decisively confirm it with a paracentesis and ultrasound was an amazing call. However, Director Cai, I wasn’t the one who made the diagnosis. It was our Dr. Wu Ting. He acted decisively. By the time Director Jiang and I reached the emergency department, he had already arranged everything."

"All I did was perform the surgery. When we opened the abdomen, even I felt a wave of retrospective fear."

"Wu Ting?"

This time, Director Cai was truly taken aback. He could have understood if it had been Huo Yun.

But for it to be Wu Ting...

"Wu Ting, I’m also curious, actually. What’s your take on this patient? Why do you think the spontaneous perforation happened?"

Huo Yun also looked at Wu Ting with some surprise.

The other doctors also turned to Wu Ting, looking perplexed.

Truly, making that diagnosis was nothing short of miraculous!

"I have to thank Director Huo for this. He’s recently had me observing numerous videos of cholecystitis surgeries and reading related journals from home and abroad."

"At the time, despite all the distracting information from the patient’s family, I performed a thorough physical exam. I considered various possibilities like peritonitis, appendicitis, and cholecystitis. Then, the family told me the patient’s gallbladder had been removed years ago."

"That actually made me consider another possibility. Although the condition is extremely rare, it’s not unheard of. Combining that with the intraoperative findings and the patient’s medical history, I have a theory."

"I believe that, first, the patient had stones in the distal end of his common bile duct, which caused a rapid increase in intraductal pressure."

"And because of his cholecystectomy, the patient had lost his gallbladder’s ability to regulate that pressure."

"Second, the stones repeatedly damaged the duct wall, leading to multiple infections and causing the wall to lose its elasticity due to fibrosis."

"Third, the patient suffers from arteriosclerosis and coronary heart disease, which likely compromised the blood vessels of the bile duct and reduced blood supply to the local tissue."

"And finally, it’s possible the patient had a congenitally weak common bile duct wall."

After Wu Ting laid out his analysis, both Huo Yun and Cai Qi expressed their strong agreement.

"Young man, that’s remarkable! To have such a profound understanding of biliary diseases at your age!"

Cai Qi was completely won over by Wu Ting’s reasoning.

"Dr. Wu, since Director Huo has you studying cholecystectomies, why not come over to our Hepatobiliary Surgery Department when you have free time? Compared to the ED, our department offers far more opportunities to experience and learn about these procedures."

Director Cai extended an olive branch to Wu Ting.

"That would be wonderful! Thank you, Director Cai."

Wu Ting was overjoyed. ’I’ve managed to get into another department!’

Huo Yun and Jiang Ming were also full of admiration for Wu Ting.

This wasn’t because of their help; Wu Ting had earned this entirely on his own merit.

...

...

「After the meeting.」

The patient was soon out of danger. When Dong Chen learned that his father would have most likely died without Wu Ting’s timely diagnosis, he was scared witless. He apologized profusely to Wu Ting, his words a jumble of gratitude and relief.

Wu Ting changed his clothes and prepared to head home for the day.

He saw Luo Xiaohu arrive at the emergency department, his face bruised and swollen. He was holding a silk banner, clearly here to apologize to Dr. Ding Yue.

Seeing Luo Xiaohu’s miserable state, Wu Ting thought, ’Looks like he got a serious beatdown last night.’

He hadn’t expected Director Zhao to actually be a man of his word.