Chapter 170: Chapter Seventy-Six: [Abdominal Madman] (Part 1)

Hu Xiaotian said, "This warm water is for you to soak your hands in; otherwise, later the blood vessels will constrict and the blood won't flow out."

Seeing the blood in the copper basin increase, Hu Jinniu trembled and said, "Family… I was asking how much more?" At this moment he realized he was afraid and actually started to get friendly with Hu Xiaotian.

Hu Xiaotian said, "Don't rush; generally, the weight of blood in the human body is about eight percent of body weight. You weigh about two hundred catties, right?"

Hu Jinniu shook his head: "One hundred eighty!"

Let me calculate: that means you have fourteen catties of blood in your body. According to my experience, losing two-thirds of blood leads to death, which means you would die after losing about one catty of blood. So far less than half a catty has flowed out—don't worry, you won't die anytime soon.

Although Zhou Ju knew Hu Xiaotian was teasing Hu Jinniu, he was still deeply impressed by his vast medical knowledge, never expecting that at such a young age he knew so much, even being able to calculate how much blood is in the human body; how could he know Hu Xiaotian studied Western medicine, having an extremely solid foundation in anatomy and physiology?

Normally, a person's blood loss at one time does not exceed four hundred milliliters, but Hu Xiaotian actually let Hu Jinniu bleed nearly two catties, estimated at around one thousand milliliters. Only then did he staunch the bleeding and suture the wound; at this moment Hu Jinniu's face was pallid, his legs went weak, and as Hu Xiaotian sutured his wound, Hu Jinniu felt a sense of having escaped death, looking at Hu Xiaotian's eyes, the earlier ferocity and hatred were gone; once a person regards another as someone who can control their life and death, they can no longer act domineering.

Hu Xiaotian looked at the blood in the basin and said, "Although it's not enough, we can only make do."

After bandaging, Hu Jinniu, supported by Nianshi, staggered out, not even wanting to stay another moment.

At this point, the preoperative preparations were nearly complete; Zhou Ju, the anesthesiologist, had already used acupuncture needles to inject the mafeisan into the patient's body,

Everything was ready except for the final push; all that remained was to wait for Hu Xiaotian, the chief surgeon, to display his skill.

Hu Xiaotian gazed at the unconscious flower-picking thief and couldn't help but smirk, "Lecherous thief! Falling into my hands, you've had eight lifetimes of bad luck."

Although he thought that way, when he actually began the surgery to save a person, Hu Xiaotian had to bring forth his best medical skill and condition. Habit and medical ethics demanded it; when facing a patient, you cannot judge him by good or evil, just as you have no right to pronounce his death sentence on the operating table.

The flower-picking thief's physical condition was not bad; he showed no signs of shock from anemia, nor of water-electrolyte imbalance, nor severe infection symptoms—this puzzled Hu Xiaotian. Upon arriving in this era, he discovered that the people here generally possess strong vitality; even serious trauma rarely leads to infection. Hu Xiaotian couldn't help but think of the various infections in modern society. Perhaps it is directly related to the overuse of antibiotics clinically; as the saying goes, the Dao rises a foot, the demon rises ten feet—some things are inherently mutually generating and overcoming.

Because of limited conditions, Hu Xiaotian had to omit the preoperative gastrointestinal decompression and enema steps; having just asked Nianshi about the medical history, this flower-picking thief has eaten nothing and drunk no water since last night, so there should be no major problem.

Using the reflective principle of a copper mirror to ensure illumination of the surgical area.

The surgical patient was placed in the supine position. Following routine, the patient was disinfected and draped; nowadays Hu Xiaotian's surgical equipment is quite complete. Zhou Ju stood beside him, temporarily serving as both anesthetist and assistant; as for others, no one is allowed to enter.

Once Hu Xiaotian entered the surgical state, his whole demeanor suddenly became serious; his mouth and nose were covered by a mask, his hair by a cap. Only his eyes were exposed; at this moment his gaze was firm and confident, he took a deep breath, and his whole person instantly entered the surgical state.

Zhou Ju stood beside Hu Xiaotian, unable to see his face clearly, yet he distinctly sensed a completely different aura from him; Hu Xiaotian gripped that narrow willow blade, making Zhou Ju feel an overbearing aura of wielding power over life and death, as if to say, who else but me? Such a feeling he had only ever experienced in the bodies of a few medical masters, and those were all grandmasters of the medical school; Zhou Ju truly could not comprehend how a mere ten-year-old boy could possess such a grandmaster's aura.

For an abdominal exploratory incision, a midline abdominal incision is usually used to allow upward, downward, or lateral extension if needed. The incision is about eight to ten centimeters long, with one-third above the umbilicus and two-thirds below. Although Murong Feiyan had previously stabbed this flower-picking thief in the abdomen, the wound was narrow, so Hu Xiaotian chose to make a new incision.

While skillfully incising the skin and muscle and separating tissues, Hu Xiaotian explained to Zhou Ju: "The standard principle for exploring abdominal trauma is: if there is massive bleeding in the abdominal cavity, first locate the source of bleeding, control it, then progressively examine other organs starting from the bleeding organ. If there is no bleeding in the cavity but gastrointestinal contents and gas are leaking, first examine the gastrointestinal tract, then the solid organs. The usual order is to examine the stomach, duodenum, biliary tract, pancreas, jejunum, ileum, colon, rectum, bladder, and so on, then check the liver and spleen, and finally examine the pelvic organs and retroperitoneal organs."

Some of these medical terms Zhou Ju had heard of, others he had never heard; he knows the five viscera, but as for the subdivisions of the small and large intestines, that is modern medicine—how would he know? As for these organs inside the abdominal cavity, he has only seen them a few times, never having performed a dissection himself, so he cannot speak of familiarity with these internal organs.

Hu Xiaotian could not possibly impart all his anatomical knowledge to Zhou Ju in a short time; he simply spoke of whatever came to mind. Nevertheless, he has completely changed Zhou Ju's medical outlook, letting him witness an entirely new field.

When Hu Xiaotian cut through the outer peritoneum, he observed that the patient's peritoneum was dark blue, indicating intra-abdominal bleeding; when the peritoneum was opened and gas escaped, it indicated a hollow organ perforation. He incised the abdominal muscular layer and had Zhou Ju help retract with hooks to separate the rectus abdominis, expanding the surgical field as much as possible.

Seeing the large bloody mess in the abdomen, Zhou Ju felt his scalp tingle; Hu Xiaotian, unfazed, smiled and said, "A belly full of bad water."

After the initial observation and judgment, Hu Xiaotian began to clear blood and effusion from the abdominal cavity. Lacking a suction device, shortly after arriving at Qingyun, he had a craftsman make an iron instrument similar in shape to a needle tube, more like a children's water pistol; this crude aspirator can suck out blood, intestinal fluid, and exudate from the abdomen.

During the suction process, Hu Xiaotian located the bleeding point; he had Zhou Ju press on it with his hand, then took a hemostat, clamped the bleeding point with the hemostat, and quickly performed vascular ligation and suturing. After initially clearing fluid or blood from the cavity, Hu Xiaotian began to explore intra-abdominal pathology. The exploration principle is to first examine normal areas, then the diseased area; the technique remains gentle and meticulous.

After ruling out lesions in the liver, esophageal hiatus, spleen region, stomach, and pancreas, the focus shifted to the small intestine. The transverse colon and its mesentery were pulled upward, the ligament of Treitz was confirmed, and the duodenojejunal flexure was identified; examination then proceeded from the jejunal origin onward. While examining the small intestine, the corresponding mesentery was checked for vascular circulation obstruction, and after each segment was examined it was promptly returned to the abdominal cavity.

The jejunum connects to the duodenum, constituting two-fifths of the small intestine and located in the left upper abdomen; the patient's problem lies here. Murong Feiyan's sword pierced his abdomen and also perforated a segment of the jejunum.

After locating the lesion and making a clear diagnosis, Hu Xiaotian decided to perform a partial bowel resection and an intestinal anastomosis.

He first determined the extent of bowel to be resected, carefully exteriorizing it through the incision. The usual surgical principle is to cut three to five centimeters proximal and distal to the diseased segment.

Hu Xiaotian carefully lifted the injured bowel to the outside of the incision, placing a large saline-soaked gauze pad between the bowel and the abdominal wall; beneath it he added two layers of dry sterile gauze, completely isolating it from the incision, thereby minimizing bowel injury as much as possible and preventing intestinal contents from contaminating the peritoneal cavity.

Watching Hu Xiaotian repeatedly lift and lower the patient's abdominal organs and intestines, Zhou Ju broke out in a cold sweat; fortunately he was mentally prepared, otherwise an ordinary person would likely regard Hu Xiaotian as a demon who disembowels and splits the belly, and would be frightened to the point of fainting.

One of the key steps in bowel resection is handling the mesenteric vessels: on both sides of the main vessel supplying the segment to be removed, create a gap to fully expose the vessel. Using two curved hemostats, clamp the vessel, then cut it between the clamps, cutting near the distal end; first ligate the distal end with suture, then the proximal end. After the first ligation, do not release the proximal hemostat; additionally, on the distal side of the suture line, wrap the suture in a figure‑eight pattern. Only then is the mesentery cut in a fan shape.

Before transecting the bowel, the mesentery of each end must first be separated from the retained bowel segment by about half a centimeter. Then check the blood supply of the retained bowel. Grasp the two ends of the segment to be resected with straight hemostats, tips pointing toward the mesentere, making an angle of about thirty degrees with the bowel's long axis; this enlarges the anastomotic opening and ensures its blood supply. Next, clamp the bowel with bowel forceps three to five centimeters from the cut edge, not too tightly—just enough to prevent luminal contents from leaking. Finally, with the straight hemostats still clamped on both ends, cut the bowel. (To be continued…)