Chen Xia thought this was not good. Was there something he had overlooked? Otherwise, wouldn't Old Qiu have suffered such a complete setback during an intestinal obstruction surgery?
So he performed a physical examination himself and found that the old man's abdomen was extremely swollen, even more exaggerated than when he was admitted to the hospital 4 days ago. This should be the reason for the full-thickness rupture of the incision.
In addition, obvious intestinal patterns can be seen on the abdominal surface, and auscultation reveals severely hyperactive bowel sounds accompanied by the sound of gas passing through water.
Chen Xia could easily determine that the old man's abdominal cavity still had mechanical obstruction, and the operation did not solve the problem. It seemed that Director Qiu had really failed this time.
Either his surgical skills were not good enough, or he did not understand the actual location of the obstruction before the operation. Either way, the operation was a failure.
The question now is no longer a melodramatic ethical drama about whether the old man is his biological grandfather, but a complex medical problem. Doctors have a natural interest in difficult and complicated diseases.
There was nothing much to say in the ward, so Chen Xia went to the office of the First Department of Surgery and asked Xie Liping to take out all the examination reports and surgical records for him to see.
"Xiao Xie, you participated in the entire operation. Were there any special circumstances during the operation?"
"Intraoperatively? Special circumstances?"
He thought carefully and then said uncertainly, "At that time, Director Qiu found that the entire cecum to sigmoid colon was also dilated. He also felt it, but found nothing abnormal. Does this count?"
Chen Xia slapped his forehead, completely speechless. "Hurry up and bring me the abdominal X-ray."
Xie Liping knew that something must have happened. Although Mr. Chen was not very old, he was able to find problems that others could not. And this patient was his grandfather, so the pressure on him increased tremendously.
Chen Xia looked at the film against the window for a long time, then said to the doctors gathered in the First Department of Surgery office:
"Look, even the upright abdominal X-ray shows the ascending colon and transverse colon. Do you understand what this means? They haven't even explored the distal sigmoid colon and rectum? Sigh..."
He suddenly realized that the level of doctors in the 1980s was really poor. Even the director Qiu Fangjue, who had seen the films and performed the surgery with his own eyes, still did not know the true meaning of cecal to sigmoid colon dilatation in intestinal obstruction.
This means that the lesion is not in the upper part or the middle part, but in the lower part, which is the rectum and anus.
It's like the rectum is a highway toll station. An accident happened here and the road was blocked. Cars were stuck at the exit and couldn't get out, which indirectly caused the entire highway to be blocked.
As a result, when the traffic police saw that the highway was blocked, they tried their best to direct traffic on the highway, but they didn't know that the problem lay at the source. What's the point of directing vehicles on the highway if you don't clear the "toll station"?
"Hurry up, get your gloves ready, I need to do a digital rectal exam."
Xie Liping quickly went to the treatment room to get a pair of rubber gloves and some lubricant. He carried them very servilely and followed Chen Xia happily. Behind him were a group of doctors from the Department of Surgery.
As soon as he entered the ward, Yang Guanshan saw so many doctors following him in and immediately became nervous, "Second Brother, what's wrong? Don't scare me."
"I need to do a checkup. Turn him sideways with his butt exposed. All of you come and help."
After preparing the body position, Chen Xia quietly put on gloves and performed a digital rectal examination. He felt a cauliflower-like mass 6 cm away from the anus, and his fingertip could hardly pass through.
The cause of obstruction is this - rectal cancer!
Xie Liping and other young doctors were shocked when they saw that Chen Laoshi's face became gloomier. They were all experts and knew what this meant.
Qiu Fangjue rushed back that afternoon and was extremely ashamed when he arrived at the office.
"Xiao Xia, ah, this time the responsibility lies with me. I was the lead surgeon. I didn't look at the film carefully before the operation, and I didn't find the problem carefully during the operation. I'm so ashamed."
Chen Xia wondered if a medical accident like this happened in a few decades, and the patient's family wouldn't give him a chance to feel ashamed. But even though he was clueless, he still understood the basics of society.
"Old Qiu, no one could have imagined this. Let's discuss the follow-up treatment for this case. This also serves as a wake-up call for us."
It was rare for everyone to see Chen Xia so serious, so everyone was silent and didn't dare to say a word, sitting in their chairs obediently.
"Intestinal obstruction and digital rectal examination are essential procedures for us. It is not only for detecting rectal cancer, but also for checking whether there is blood on the finger cuff, whether there is intussusception, etc. In addition, it can sometimes also feel whether there is stenosis at the anastomosis site after rectal cancer surgery.
Therefore, digital rectal examination is necessary for patients with intestinal obstruction, and the second is to check the inguinal area to rule out the presence of incarcerated hernia. These are all basic skills.
While auxiliary examinations are important, we can't neglect the most basic things. Some doctors now rely too much on examinations, forgetting sight, touch, and hearing. Honestly, some doctors probably can't even tell a man's prostate from a digital rectal exam, or a woman's cervix from a tumor, right?
Several young doctors present hurriedly lowered their heads. Although Mr. Chen did not name any of them, they felt guilty, as if he was talking about themselves. They made up their minds to practice basic skills diligently.
Chen Xia is still continuing to review:
"So you should be skeptical of everything you encounter in your future work. Don't completely trust other doctors' diagnoses, including auxiliary tests. You should have your own ideas and not let them be buried in the thoughts of others. Don't just follow the crowd."
After he finished saying this, he suddenly realized that he seemed to have said the wrong thing. The surgeon in charge was Director Qiu, and he sounded like he was blaming Director Qiu by saying this. This old intellectual can change his attitude faster than turning the pages of a book.
His strong desire to survive made him add immediately, "So, from now on, don't just blindly believe whatever report the auxiliary examination department gives you. After receiving the report, you must think carefully and make your own judgment."
Sure enough, after hearing this explanation, Qiu Fangjue's expression relaxed. Chen Xia stole a glance at him and was so scared that she wanted to pat her chest.
"Finally, I think we overlooked one point: the patient's hemoglobin was only 74 and his albumin was only 21. Did we consider the possibility of a chronic wasting disease beforehand? Now, looking back at my grandfather's clinical manifestations, don't you think this is very typical, very obvious, almost like a free test?"
The young doctors nodded frantically, thinking that Mr. Chen was criticizing everyone because he was unhappy because his grandfather had cancer.
In fact, they had no idea that Chen Xia didn't care about Old Man Yang's life or death. He thought that such a heartless old man should die early and be reincarnated sooner. He simply wanted to teach these young people a lesson.
That's all.
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