CHAPTER 353: 353 PATIENTS WITH APPENDICITIS DUE TO INTESTINAL PERFORATION

(Thanks to my friend Sleepyhead for the generous gifts and for their monthly tickets, and to my friends hkatc123, Night Stands, Xykd007, Forgetting My Past, and Wind Thought for their encouraging monthly tickets.)

Liu Banxia’s diagnosis was spot on. After Wang Huan completed a stool test and a gastrointestinal X-ray, Wang Huan was diagnosed with celiac disease. This earned Liu Banxia 500 experience points, 800 diagnostic skill proficiency, and 10 Glory Points.

During dinner, Wei Yuan also lived up to his promise and added a chicken leg to everyone’s meal. Things like adding extra chicken legs or dishes usually only happened in the Emergency Center. Moreover, everyone gladly accepted the additions, as this usually signified good news.

Despite Liu Banxia being just a resident physician at the moment, he had nurtured valuable helpers. Unless there was an emergency or a major one, the group of interns led by Liang Xiaolin usually handled things.

That night was rather peaceful. However, Liu Banxia anticipated a wave of brawls and alcohol-related incidents during the New Year’s Day holiday, as year-end parties often led to excessive drinking and fights.

By ten o’clock in the evening, Liu Banxia retired to the on-call room to sleep. He set his alarm for four in the morning so he could take over someone’s shift, allowing others to sleep a bit longer. This sleeping schedule was quite exhausting, but as the chief resident, he felt he had to create convenient conditions for his colleagues. Sleeping from four to eight in the morning, though only four hours, could help them recover a lot of energy.

While he was deep in slumber, he felt someone shaking him and he sat up reflexively.

"Dr. Liu, the patient who had a laparoscopic appendectomy today is experiencing abdominal pain. Doctor Xu has taken them for a CT scan, suspecting an intestinal perforation," Nurse Chen Min reported.

Liu Banxia shook his head to clear it. "Book an operating room and give me the patient’s ID number."

"It’s already logged into the computer," Chen Min replied.

Liu Banxia nodded and immediately left the room.

"President Liu, Xu Yino just consulted me about it. I’m afraid I can’t handle it," said Wang Chao, who was on duty.

"Alright, let’s wait for the results," Liu Banxia said.

He was slightly puzzled. A patient admitted for acute abdominal pain, appendicitis confirmed, appendix removed—how on earth had they ended up with an intestinal perforation now?

After a while, the information on the computer screen refreshed.

It was indeed an intestinal perforation, located in the colon, and it needed to be dealt with promptly. The colon contains a vast number of bacteria; leakage of intestinal contents could easily lead to peritonitis or septicemia.

"Inform Xu Yino to send the patient directly to the operating room." With that, Liu Banxia headed for the elevator.

Even with the confirmation, he was still puzzled. Why did this patient have an intestinal perforation? It simply didn’t make sense.

"Why did you come up? I thought it would be Xu Yino and the team," Wang Lei asked with a smile, seeing Liu Banxia walk into the operating room.

"I’m a little uneasy. By the way, you assisted with the appendectomy earlier, right? Was there anything unusual then?" Liu Banxia asked.

Wang Lei shook his head. "Nothing unusual. It was just a normal appendectomy. The appendix was inflamed, with slight suppuration, but thankfully, it hadn’t perforated."

Liu Banxia nodded. "We’ll do an open abdominal surgery; it’s better for handling a colon perforation. We’ll also examine the patient’s entire intestinal tract to check for any other lesions."

"OK," Wang Lei responded.

"Xu Dan, aren’t you tired from getting up in the middle of the night?" Liu Banxia looked at Xu Dan next.

"So tired. I’m exhausted. I’m starting to regret this; it’s been so long since I’ve had a full night’s sleep," Xu Dan said pitifully.

"Don’t regret it. Everyone says you’re progressing rapidly. Soon enough, you’ll probably be able to handle procedures independently, without supervision," Liu Banxia complimented.

"Really? Haha, that’s great!" Xu Dan grinned happily.

The others in the operating room were amused. They all liked Xu Dan, not because the renowned Director of Neurosurgery, Xiao Zhaoqiu, had her back, but because of her easy-going nature.

Just then, Xu Yino brought the patient into the operating room. Liu Banxia gave her a reassuring look. "Has the surgery been clearly explained to the patient?"

"Doctor, please check carefully so there won’t be any more problems with my abdomen." Before Xu Yino could respond, the patient spoke up.

"Rest assured. It’s very rare to develop an intestinal perforation after appendicitis. Once you’ve recovered, you should go buy a lottery ticket; you might just hit the jackpot," Liu Banxia said with a smile.

"Ah... I don’t care about any lottery. I just want the pain to stop," the patient grimaced.

"Absolutely. With an optimistic patient like you, I have to do an especially clean job. It seems the perforation isn’t too severe, so we probably won’t need to resect any intestine. My suturing skills are the best in the Emergency Center, believe me?" Liu Banxia asked.

"I believe you. Doctor Xu told me to find you. You’ve even been on TV," the patient chimed in.

Wang Lei, watching from the side, was a bit perplexed; he’d never seen such an optimistic patient before.

But the chit-chat had to end. It was time for the anesthesia.

"Xu Yino, open him up," Liu Banxia instructed after the anesthesia took effect.

Xu Yino didn’t hesitate and immediately picked up the scalpel to begin the operation.

Actually, an intestinal perforation repair isn’t a particularly complicated procedure. If not for this patient’s unusual circumstances, Liu Banxia could have opted for laparoscopic surgery. But that wasn’t an option now. Only a laparotomy with a thorough exploration could eliminate any hidden dangers.

Xu Yino’s technique was standard. Once the abdomen was open, the colonic perforation was immediately visible. This saved Liu Banxia the trouble of searching for it.

The rest was routine, something Xu Yino was capable of handling, but Liu Banxia still chose to do it himself. He had made a promise to the patient, so he couldn’t cut corners.

After completing the suturing and thoroughly irrigating the abdominal cavity, Liu Banxia didn’t rush Xu Yino to close. Instead, he proceeded with a careful inspection.

"Banxia, we need to speed up. It hasn’t been long since his last general anesthesia, and his vital signs are a bit low," Wang Lei reminded.

"Three more minutes," Liu Banxia replied.

Three minutes might seem short to others, but for the current Liu Banxia, it was a significant amount of time. He just needed a quick look at the intestinal tract for any other potential lesions. However, after the inspection, he found nothing else wrong, so he had Xu Yino close the abdomen.

DING! Surgery completed.

Awarded: 200 Experience Points, 100 Diagnostics Skill Proficiency, 200 Suturing Skill Proficiency, 100 Dressing Change Skill Proficiency, 1 Glory Point.

Surgery Rating: Perfect. Awarded: 300 Experience Points, 100 Diagnostics Skill Proficiency, 200 Suturing Skill Proficiency, 100 Dressing Change Skill Proficiency, 5 Glory Points.

"Teacher Liu, what do you think caused it?" Xu Yino asked while they waited for the patient to recover.

"I’m not sure at the moment. Superficially, at least, the rest of the intestines look fine," Liu Banxia replied. "You must have been scared, right? Don’t worry too much. First, don’t panic; many postoperative complications can occur. As for what caused this perforation, let’s wait until the patient wakes up and ask him then."

"I already asked him. He said he hasn’t suffered any external trauma like a blow or impact. And he has no history of stomach pain or gastric ulcers. I’m worried sick," Xu Yino said.

Liu Banxia nodded and shifted his focus back to the patient.

Comforting words alone wouldn’t suffice; that was just external support. Xu Yino had to learn to bear this herself, little by little. Others couldn’t truly help.

"Is the surgery over?" After a while, the weakened patient asked.

"Yes, it’s over. I also carefully checked your intestines and found no other lesions," Liu Banxia replied.

The patient nodded. Just then, he twitched involuntarily a couple of times.

"Did you just feel something?" Liu Banxia asked immediately.

Wang Lei, at his side, also grew tense, wondering if there was a problem with the anesthesia.

"I just had a sudden muscle spasm. Why can’t I see you all clearly? My vision is a bit blurry. It wasn’t like this when I woke up from the last surgery. What’s going on?" the patient asked.

"Can you see how many fingers I am holding up?" Liu Banxia held up two fingers before the patient’s eyes.

"Two, I can see that, it’s just a bit fuzzy, not very clear," the patient explained. "An intestinal surgery couldn’t have messed up my vision, could it? I’m still quite young, and I’m a bit nearsighted. It shouldn’t be age-related farsightedness."

DING! Task released: Appendicitis patient with perforated intestine.

Open task: The patient had developed a perforated intestine and blurry vision after an appendectomy, potentially due to an underlying disease. Host needs to diagnose further. Rewards will be provided based on the diagnostic results.

Although the patient was still optimistic and speaking humorously, Liu Banxia couldn’t share his lightheartedness.

After a moment of contemplation, he said, "Xu Yino, arrange for a cranial CT scan for the patient, and a blood test as well."

"Drawing blood again? That’s going to be a few tubes," the patient grumbled.

Xu Yino didn’t dare respond and, with another nurse, quickly wheeled the patient out.

"Banxia, could it be the effects of anesthesia?" Wang Lei asked.

Liu Banxia shook his head. "Unlikely. If it were due to anesthesia, the effects would typically manifest right when he woke up. He’s been talking for a while now, and his thinking is clear. It’s not the anesthesia."

"I wonder if a blood clot is pressing on the optic nerve. His vision was blurry just now, but there was no nystagmus or strabismus. Let’s see the CT results. This case seems quite complex."

Now that the patient is showing signs of a neurological issue, we must figure out the cause today. His condition is progressing too rapidly; this illness seems acute.

Another point supporting his judgment was the task issued by the system. If it were a simple eye condition, given his current diagnostic skill proficiency, the system likely wouldn’t have issued a task.

After leaving the operating room, Liu Banxia rubbed his face. Despite having just finished a surgery, his mental alertness was still a bit lacking; he needed to wake himself up properly.