Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

It is likely that the patient's intestines were perforated, and the feces leaked from the intestines flowed into the abdominal cavity.

Of course, judging from the paracentesis fluid alone, it is not [-]% sure that the patient must have intestinal perforation.

Yin Liang immediately handed the puncture fluid in his hand to an intern, and said, "Take this pericentesis fluid and send it to the laboratory for urgent biochemical, routine, and bacteriological examination!"

With the biochemical examination of the paracentesis fluid, after the results come out, it is basically possible to confirm what it is.

Lin Yi and Yin Liang returned to the doctor's office, waiting for the test results of the paracentesis fluid.

In about half an hour, the results of the laboratory were uploaded to the computer.

The results showed that the ascites contained Enterococcus faecium.

Enterococcus faecium is a bacterium that only exists in the intestinal tract and does not appear in the abdominal cavity.

However, if this bacterium is found in the ascites, it means that the patient's intestine must have been perforated.

After seeing the test results, Yin Liang had completely believed in Lin Yi's judgment.

He shook his head involuntarily, and said convincingly: "Brother Yi, you are still the best. Neither B-ultrasound nor CT could find out the cause of this patient, but you were able to find it out, admiration!"

Of course, Lin Yi would not be complacent because of Yin Liang's admiration.

Instead, he said: "We don't need to brag about each other in this business. Now that the cause of the disease has been clarified, I think it's better to perform an exploratory laparotomy on the patient, otherwise, if the delay continues, his condition will only get worse! "

Yin Liang nodded repeatedly.

"That's right, I'm going to talk to the patient's family members now and make preoperative preparations."

Yin Liang said, got up and walked out the door.

Before walking out of the door, he stopped suddenly, looked back at Lin Yi and asked, "This laparotomy, do you want to go on stage?"

Exploratory laparotomy, especially the highly suspected operation of sigmoid colon perforation, coupled with the gangrene of the gallbladder that Lin Yi has not mentioned, will definitely require removal of the gallbladder. It is still very difficult to perform these two operations together.

Lin Yi was very happy to have the operation.

For this operation, he knew that it was impossible for him to be the chief surgeon.

Because of this, he was willing to be Lin Yi's first assistant.

Seeing that he could be Lin Yi's assistant, Yin Liang immediately went to talk to the patient's family and signed the consent form for the operation.

Now Lin Yi's surgical ability is at the peak of his power in the emergency department, and the doctor who wants to be his surgical assistant beats his head.

And now this operation happens to be the patient that Yin Liang manages by himself, so the natural first assistant is his.

Since the patient's condition was very serious and there was no need to delay, Yin Liang signed the operation consent form with his family members very quickly.

After a short time, the patient was sent to the emergency operating room.

I heard that Lin Yi was going to have another operation, and many people came to the operating room to observe.

The position of the second assistant was taken by Song Borui.

Several other interns or fellow doctors also wanted to get the position of second assistant, but they couldn't compete with Song Borui.

After all, Song Borui is the attending physician of the hospital, no intern or fellow doctor would dare to compete with him.

Brush your hands well, put on sterile gowns, put on sterile gloves, and disinfect the towels.

When preparing for the operation, Lin Yi said a word slowly.

"I always feel that this patient not only has a perforated colon, but may also have gallbladder problems. Let's make the incision longer today."

Yin Liang was immediately surprised and said: "No way, Lin Yi, I obviously checked his abdominal CT and color Doppler ultrasound, but it only indicated cholecystitis, and I didn't see any major problems with the gallbladder.

"It's impossible to say!"

Lin Yi just smiled, stopped talking, and began to focus on the operation.

Although this patient had undergone abdominal CT and abdominal color Doppler ultrasound, it only indicated cholecystitis.

Because the patient's condition is more complicated, even if relevant examinations are done, it is possible to cover up the condition.

Therefore, the auxiliary examination can only be used as a reference, and the disease cannot be diagnosed completely by the auxiliary examination.

After the anesthesia took effect, Lin Yi made a 12cm incision in the middle around the navel and entered the abdomen layer by layer.

Exploration shows: the abdominal cavity is severely jaundiced, and some small intestines are adhered to each other into groups.

Exploration revealed the formation of bilateral subdiaphragmatic, intestinal space, and pelvic abscesses with a large amount of pus attached.

When a large number of abscesses were detected in the pelvic cavity, Yin Liang immediately exclaimed.

"I'll go, it really is an abdominal infection. An abscess has already formed, which is too serious!"

Yin Liang cooperated with Lin Yi to remove part of the pus moss and suck out about 900m1 of turbid yellow-white pus.

The middle section of the sigmoid colon was found on exploration, and a necrotic perforation of the intestinal wall was seen, with a diameter of about 0.8 cm. The intestinal wall around the perforation showed carbon-like changes.

Seeing the perforation of the sigmoid colon, Yin Liang immediately widened his eyes and looked at Lin Yi in disbelief.

"Brother Yi, you are actually right, and it is really a perforation of the sigmoid colon. You are not wrong at all!"

But Lin Yi didn't speak, just smiled and continued the operation.

Severe segmental inflammatory changes in part of the small intestine were detected, with local ischemia-like changes in the form of dots.

The gallbladder wall was found to be punctate gangrene on exploration, with severe yellow staining around the gallbladder.

When Lin Yi went to the upper part of the abdominal cavity to detect the gallbladder, he found that the gallbladder was suppurative and gangrene.

Yin Liang was suddenly speechless in shock.

He was stunned for a while, and then he said hesitantly: "Brother Yi, you are really amazing! Before the operation, you said that this patient may also have gallbladder problems. I thought you were joking. I didn't expect this patient, It turned out to be a real problem with the gallbladder, you are really amazing!"

However, during the operation, such a big problem was discovered.

This patient will definitely have a colostomy, a partial sigmoidectomy, and a cholecystectomy.

This requires explaining the situation to the family.

As the doctor in charge of this patient, Yin Liang took off his gloves and took a picture of the patient's abdominal cavity with his mobile phone.

Then he walked out of the operating room and explained the next operation to the family members waiting at the door.

A laparotomy, that's it.

Generally, during the operation, if any problem is found, it is necessary to communicate with the family members in time to facilitate better surgery in the future.

In just a few minutes, Yin Liang had already discussed the details of the operation with the patient's family.

He brushed his hands again, changed into a surgical gown and sterile gloves, and stood in the position of the first assistant again.

Now that Yin Liang had explained the situation to his family, Lin Yi began to perform the next operation.

The patient underwent surgery, and what is now discovered is perforation of the sigmoid colon, gangrene of the gallbladder, and abdominal abscess.

Abdominal abscess caused intestinal adhesions, which required lysis of intestinal adhesions.

Because after partial sigmoid colon resection, because of severe abdominal infection, severe intestinal wall edema.

It is definitely not possible to anastomose the intestinal tract immediately, so a colostomy opening is also needed.

It is to sew the colon near the heart to the abdominal wall, and connect a fecal bag outside to allow the stool to be discharged from the abdominal wall.

That is to say, in the next few months, the patient has been carrying a fecal bag for life.

Enjoying the influence of the smell all day long, the quality of life will naturally be much worse.

But compared to life, this is the best choice.

After a few months, the edema of the intestinal wall disappeared, and the inflammation completely disappeared, and the sigmoid colon could be re-anastomized.

At that time, the patient can return to normal life.

After deciding on the operation plan, Lin Yi started to do it.

Fully expose the operative field, bluntly dissect the abdominal adhesions, thoroughly remove the peritoneal pus and necrotic tissue again, rinse the peritoneal cavity with an appropriate amount of saline, and aspirate it.

Lin Yi did these operations very quickly.

Yin Liang and Song Borui were dazzled.

The interns and fellow doctors around couldn't keep up with Lin Yi's pace.

The first thing Lin Yi did was a partial sigmoidectomy and then a colostomy.

This operation is relatively simple, and he performed it relatively quickly.

First, Lin Yi cut off the intestinal tube about 2cm above and below the perforation of the sigmoid colon, cut off the corresponding mesentery, and accurately stopped the bleeding.

The distal interrupted silk thread was reinforced and left aside, and the proximal intestinal canal came out of the left abdominal wall fistula, and the interrupted silk thread was fixed.

This part of the sigmoid colon resection and fistula is completed, very simple operation.

For Lin Yi, the operation was very simple.

But for Yin Liang and Song Borui, as well as the interns and advanced students around them, it was quite difficult.

Surgery is easier said than done.

It is typical that the eyes can, but the hands can't.

Regardless of any operation, there is no need to go through countless operations on stage.

Surgical procedures, no matter how proficient you memorize them, you cannot become a good doctor.

Because sigmoid colon resection is relatively simple, Lin Yi didn't explain too much.

Instead, he quickly completed the operation, and what he will do next is the entire cholecystectomy.

This operation is slightly more difficult than the sigmoid resection.

So Lin Yi slowed down a little, and then explained the steps in detail to the people around him.

Lin Yi explained the steps while operating carefully.

In the eyes of everyone, Lin Yi's operation is simply smooth and smooth.

There is a feeling that he is not doing an operation, but a handicraft.

Gives a pleasant feeling.

After treating the sigmoid colon, Lin Yi clamped the bottom of the gallbladder with non-invasive forceps, and cut the gallbladder serosa along both sides of the gallbladder.

From the bottom of the gallbladder, free the gallbladder to the neck of the gallbladder.

The hepatoduodenal ligament and foramen of Winslow were exposed, and the cystic duct was found by blunt dissection.

Poster and superior to the cystic duct, the cystic artery is separated.

When separating the cystic artery, Lin Yi also emphasized it to the surrounding doctors.

"When separating the cystic artery, you must be careful, the action must be gentle, and you must not be rough, otherwise it will be very troublesome to tear off the cystic artery!"

Lin Yi continued the operation while talking.

Near the gallbladder wall, the cystic artery was cut off, the cystic duct was cut 0.5 cm away from the common bile duct, and the proximal end was double ligated.

After removal of the gallbladder, the gallbladder bed was completely hemostasis.

At this point in the operation, the entire operation is considered complete.

The rest of the work is finishing.

Lin Yi handed it over to them to complete.

After walking out of the operating room, in the emergency room, an old man in his 60s lay unconscious on the ground.

An old lady in her 60s, who seems to be his wife, has been scared to death by the old man.

While crying: "Old man, don't scare me, wake up quickly."

While turning his head from time to time, he shouted in a panic: "Come to the doctor and save me."

A nurse rushed to the old man and knelt down to check his pulse.

She first let the old man lie flat on the ground, tilt his neck back, and completely open the airway to prevent the unconscious old man from suffocating.

After touching his carotid artery, his heart beat was normal and his breathing was OK.

At this time, the nurse's heart relaxed a little, but she couldn't judge the specific situation of the old man, and had to wait for the doctor's arrival.

At this moment, Lin Yi and a group of people hurried to the old man's side.

At this time, Zhou Chao, the director of the emergency department, happened to be here.

So he rushed up immediately, knelt down to check on the situation of the old man.

Although there were quite a few doctors around, she was on duty today after all, so she was the doctor who needed to see her first.

Zhou Chao checked the old man's pulse, looked at his pupils, and listened to his heart and lungs again.

Then he looked up at Lin Yi and said: "Now the patient is in a coma state, and the pupils on both sides are unequal, and the formation of brain herniation is considered. However, further head CT examinations are needed to confirm."

After Zhou Chao finished speaking, he turned to look at the old lady beside him and asked, "Old lady, did the patient have high blood pressure before?"

The old lady hurriedly nodded and replied: "The old man has high blood pressure, and he is taking medicine, but the drop is not satisfactory, so I plan to come back to see it today, but who knows that he suddenly passed out here."

The old lady was so sad that she wanted to shed tears: "Doctor, is my wife okay?"

Seeing the old lady's eager expression, Zhou Chao immediately comforted him: "Old lady, don't be anxious, let's check the old man first, and then we can clarify the condition."

Then he said to the nurse assistant beside him, "Hurry up and push the gurney, and push the patient into the emergency room."

The nurse quickly pushed over a gurney, and everyone worked together to lift the patient onto the gurney, and then pushed it to the emergency room.

The nurse hastily inhaled oxygen for the patient and connected to the ECG monitor.

Soon the patient's vital signs were displayed on the monitor.

The monitor showed that the blood oxygen saturation was 98%, while the blood pressure was as high as 200/100 mmHg.

Judging from the patient's blood pressure as high as grade 3, the patient is most likely to have a problem with the cerebrovascular, and the most likely is cerebral hemorrhage.

Because just now Zhou Chao had discovered that the patient's pupils were not equal in size.

Bilateral pupillary unequal size is an important sign of cerebrovascular problems.

In patients who suddenly coma without any warning, the most common causes are cerebrovascular disease and cardiovascular disease, and there is also a hypoglycemic coma.

When encountering this kind of sudden coma patient, a clear examination must be carried out first to clarify the condition before further treatment.

At present, the patient's blood oxygen saturation is as high as 98%, which means that the respiratory function is acceptable.

Therefore, only the nasal cannula is needed to inhale oxygen, and the ventilator is not used for the time being.

Zhou Chao immediately issued a doctor's order to ask the nurse to draw blood for relevant examinations, and soon the blood sugar results were not low.

Hypoglycemic coma can be ruled out.

After an electrocardiogram, it showed that there was only some myocardial ischemia, but it would not cause coma.

Therefore, the current patient is most likely coma caused by cerebral hemorrhage.