CHAPTER 354: 354 INTESTINAL PERFORATION IS ONE OF THE SYMPTOMS

"The cingulate cortex appears a little blurry?" Seeing the latest CT results, Liu Banxia couldn’t help but murmur.

"Teacher Liu, does this mean that the patient’s frequent joking and good mood are not due to his inherent personality?" Xu Yino asked.

Liu Banxia nodded. "The cingulate cortex can affect emotions, so the patient’s cheerful behavior could be a symptom. However, this doesn’t explain his blurred vision, and there’s no indication of a blockage in the blood vessels."

"Who’s on duty tonight in the Neurology Department? Even though it’s late, we should still inform them. We aren’t experts in this field, and we don’t want to overlook anything that could worsen the patient’s condition."

Xu Yino quickly went to find Zhang Ping, the neurologist on duty.

The one most worried was her; the patient had been diagnosed by her, and she had led the surgery. Who would have thought that a simple appendicitis operation would lead to intestinal perforation and blurred vision? Even if the blurred vision can be linked to a brain lesion, what caused the intestinal perforation? She had a vague feeling that it was connected to appendicitis.

"Dr. Zhang, these are the patient’s CT scans. He was admitted with acute abdominal pain and diagnosed with appendicitis. After the removal of the appendix, he developed an intestinal perforation. Right after the repair surgery, he started experiencing blurred vision," Liu Banxia explained. "These are the latest CT scans. The blood test shows a significant increase in white blood cells. However, after two surgeries, this should still be within the normal range, right?"

"Let me have a look. This seems quite complicated," Zhang Ping said, rubbing his eyes.

"Going by the current blurry presentation, it seems like there’s inflammation caused by some virus or abscess that’s affecting his emotional area. Our only course of action is to test the cerebrospinal fluid and see what we find."

"From this scan, we can’t really pinpoint what’s causing his blurred vision, can we? Wang Lei is also worried. He just texted me, wanting to know if it’s a post-surgery reaction from the anesthesia," Liu Banxia said with a bitter laugh.

"That’s unlikely. It’s probably mostly due to the inflammation," Zhang Ping replied.

"Wang Chao, could you help run the tests? I’ll continue to study the data," Liu Banxia asked.

Wang Chao nodded. This was something that required discussion with the patient and his family. However, they generally wouldn’t object, especially since the brain CT scans had already revealed issues.

"Dr. Liu, I still feel the patient’s appendicitis is related to his intestinal perforation," Xu Yino said, her face etched with worry.

Liu Banxia nodded. "I also think there’s a connection; otherwise, it’s too coincidental. And I’ve been thinking, the patient’s white blood cell count is really a bit too high. But he’s been through two surgeries, and there’s also some inflammation in his brain, so it’s consistent with the current symptoms. But what exactly is going on? Even if it’s encephalitis, shouldn’t that have nothing to do with the intestinal perforation?"

Xu Yino opened her mouth, but this situation was way beyond her comprehension.

"Don’t worry," Liu Banxia comforted her. "I reviewed your admission process, and it was flawless. The indicators were clear when the patient came for the consultation. Even if the appendicitis and the perforation are manifestations of the same disease, your handling of the case was by the book."

"Hmm... If both are manifestations of the same disease, could it be due to parasites? Hmm...? Holy crap, could it be amebiasis? After the patient is done with the puncture, let’s follow up with a stool test. The symptoms all line up: appendicitis, intestinal perforation, elevated white cells, inflammation in the brain. The more I look at it, the more it seems like it."

"That’s very likely," Zhang Ping agreed. "Amebae primarily infest the colon and the cecum. If some parasites moved into the appendix, it could cause appendicitis."

"Besides, this type of parasite also corrodes the intestinal wall, causing ulcers, which could explain the patient’s subsequent intestinal perforation. Considering the patient’s current state, it’s possible the parasites have already migrated to his brain."

"Dr. Liu, could we treat this with metronidazole?" Xu Yino asked.

Liu Banxia shook his head. "Let’s see if there are cysts in the brain. If there are, not only will they be hard to clean up, but the prognosis is also very poor. Let’s do the tests first. After confirming the diagnosis, perhaps we can follow up with an MRI?"

Zhang Ping nodded. "That’s the only way. It’s up to his luck now. Hopefully, it’s just brain inflammation caused by the parasitic infection, and the parasites haven’t actually migrated."

"What puzzles me is why I didn’t think of this first is because the current month doesn’t fit," Liu Banxia said with a bitter smile. "It’s already cold, and it has even snowed twice. Amoebae mostly live in warm and humid areas of tropical and subtropical climates. Our region doesn’t fit that description at all."

"Even considering the incubation period, it wouldn’t be as long as one or two months. About ten days sounds right. How could it have incubated for so long?"

"President Liu, you’ve overlooked something," Zhang Ping said with a chuckle. "Amoebae don’t move around, but people do. People can fly all over the place. Who knows where he might have been?"

Liu Banxia slapped his forehead. He was right! My thinking was too limited. With today’s advanced transportation, the patient really could have traveled anywhere.

The conventional order of examination should include a colonoscopy for a clearer view. However, the patient just had surgery for intestinal perforation, and a colonoscopy could potentially damage the perforated site. Nevertheless, a diagnosis could be confirmed with the available techniques. If trophozoites engulfing red blood cells were discovered in a stool examination and high concentrations of amebic antibodies were found in the serum, a diagnosis could be confirmed.

"Teacher Liu, we can make a diagnosis now! The brain only has some infection; no trophozoites were found in the cerebrospinal fluid." After a flurry of activity, Xu Yino ran over with the report, beaming.

DING! Patient consultation completed.

Gained 100 experience points, 100 Diagnostics skill proficiency points.

Liu Banxia nodded. "I’ll leave informing the family to you. Once the patient is awake, conduct the relevant inquiries. Find out if his family members share his travel history or consumed the same food from outside the region, and so on. Furthermore, properly organize this case as a typical case study for everyone. It can serve as a warning so that no one is caught off guard when faced with similar diseases in the future."

"Okay, Teacher Liu, you should get some sleep," Xu Yino replied cheerfully.

She had always been worried about this patient’s condition, especially fearing that her laparoscopic appendectomy might have caused his intestinal perforation. Intestinal perforation can be a minor issue or a major one. At its least severe, it can be repaired. At its most severe, it can be life-threatening. And regardless of whether her operation was the cause, the fact that the patient developed an intestinal perforation after admission and surgery—even if no procedural errors were found—made her feel it was due to her own lack of meticulousness.

If Teacher Liu had been the one to first see this patient, he might have ordered further examinations based on some of the initial signs, instead of just focusing on appendicitis.

After all the commotion, Liu Banxia wasn’t really sleepy. He told Wang Chao and the others to go rest while he stayed on duty.

The signs in today’s patient were actually very clear. It’s just that even I didn’t think too deeply about it. Fortunately, we didn’t delay his treatment. Otherwise, after his surgical wound healed, we’d still be trying to figure out why his white blood cell count was so high. It would have taken a lot more effort and time to finally diagnose his condition.

"Why don’t you get some rest?" After finishing the remaining case files, Liu Banxia saw Xu Yino still there and asked with a smile.

"Teacher Liu, I can’t sleep," Xu Yino said. "After talking to the patient’s wife, I found out the patient actually went on a business trip a week ago."

"He was probably infected while he was out and about locally. Otherwise, there’s no other source of contact. I’ve also notified his three colleagues; they will come over for check-ups tomorrow."

"You should rest too, so you can see these patients tomorrow and conduct detailed examinations," Liu Banxia said.

"You did well today, but you should have more confidence in the future. Your professional skills are already quite good; you can handle routine surgeries."

"Thank you, Dr. Liu," Xu Yino said, grinning and nodding.

For her, such praise from Liu Banxia was a rare treat. Especially since she was an intern who hadn’t even graduated yet, she had already gained a lot of hands-on experience here.

Liu Banxia paid no further attention to her. Participating in the diagnosis and treatment of such a case, he recalled, would have made him just as excited in the past. But having seen so many patients, it seemed that nowadays, only emergency surgeries could give him that same feeling.

He began to ponder while awaiting breakfast.

Perhaps they could introduce weekly, unscheduled meetings in the Emergency Center? They could analyze cases and discuss medical incidents together. That would surely deepen everyone’s understanding.

While Second Hospital did hold such meetings, they mostly focused on praising outstanding diagnoses, with fewer discussions on medical incidents. Although some cases might not be classified as medical incidents, if a bit more attention was paid during admission and diagnosis, and if they kept a more open mind, perhaps different outcomes could be achieved.

Anyway, as the Emergency Center operated independently, they could later gather all the doctors in an upstairs conference room to have their own discussions.

The Emergency Center was not only a department highly valued by the hospital but also the place where he was truly pouring his efforts. Ever since its establishment, he had been working there. Despite a few minor incidents, his affection for the place hadn’t changed.

As for him now, there was basically no chance of changing jobs. He would spend his entire life at Second Hospital, and he had to build up the Emergency Center well.