It looks like a patient who has just undergone surgery.
The liquid in the drainage bag was a little cloudy, yellow, white and black, probably because there was pus and leakage with a little feces. The patient's temperature was high, 38.9 degrees.
"Is this patient a cancer patient?" Without seeing the medical records, Feng Yicong and Xie discussed among themselves. The patient was too young, so the possibility of him being a cancer patient was relatively small.
Xie Wanying agreed with her classmates' point of view. It is not only cancer patients who can undergo surgery. In her opinion, the fact that this case was transferred to the National Association for treatment showed that it had some characteristics that the National Association was good at treating, so she boldly inferred: "It may be Crohn's disease."
Crohn's disease is a mysterious intestinal inflammation. The reason why it is mysterious is that the medical community is still at a loss as to its pathogenesis. It could be an infection or an immune disease. In short, there are many possible causes.
Doctors are helpless when the cause of the disease is unknown. Therefore, the clinical treatment of Crohn's disease is symptomatic treatment and immunotherapy based on existing evidence related to immunology. This is what the National Association is good at, because the immunology discipline of the National Association is well-known in China, and no one dares to rank second. If this young person has this disease and has reached the stage of surgery, it means that the disease has entered a serious stage. It may be intestinal obstruction, intestinal fistula, or acute perforation and bleeding.
A typical clinical feature of Crohn's disease is fistula formation. Inflammatory lesions penetrate the intestinal wall and reach other tissues and organs outside the intestine, forming fistulas. These fistulas cause adhesions between organs and tissues, forming a mass abscess. Anyone who has studied general surgery has experienced how terrible abdominal abscesses are.
If an abscess is actually formed, it is not appropriate to immediately perform surgery to remove the diseased intestinal segment. Incision and drainage of the abdominal abscess must be performed first. Incision and drainage of abdominal abscess requires laparotomy, which is not an ordinary bedside puncture with a needle. General anesthesia, spinal anesthesia, or epidural anesthesia is required. The skin, subcutaneous tissue, and peritoneum are cut open, the abdominal cavity is opened, the inflammatory mass is found, and the mass is isolated with gauze to prevent the spread of infection. The abscess is incised to drain the pus, and finally a drainage tube is inserted and the cavity is closed.
The patient has now entered the surgical stage but has been transferred to the National Association for the Treatment of Pediatric Surgery. Should he continue with surgical treatment or switch to internal medicine treatment?
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After studying the medical records, Yu Xuexian asked the family members to come over for a talk. Feng Yicong asked Xie again: "Do you want to go to the internal medicine department for treatment? After the surgery, there are still signs of increased pus. The surgery department can't handle it properly, so we should consider conservative treatment in the internal medicine department, because our gastroenterology department is good at studying Crohn's disease."
Listening to what Feng said, it is clear that he is an internal medicine student who knows internal medicine very well.
There was a lot of pus in the patient's drainage bag, which meant that if the surgery was not done well, it would not be effective in alleviating the patient's condition. It was the usual reasoning to transfer him to the internal medicine department.
Without jumping to conclusions, Xie Wanying looked at the patient's abdominal drainage tube and began to think further.
As a surgical student, I have the mindset of a surgeon, which is different from the mindset of an internal medicine student like Mr. Feng, so the direction of my considerations is not quite the same.
Having worked in two surgical departments, in addition to performing surgeries with her teachers and senior colleagues, Xie Wanying learned the most about how to deal with patients before and after operations.
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