Chapter 145: 0142 Couple's Fight, Don't Move the Knife (Part 1)

Let Xie Yiren notify that group of mahjong‑playing decadent and licentious guys to come work overtime; Zheng Ren stuffed the remaining meat into his mouth in two or three bites.

On the first floor Emergency Department, a woman stood helplessly inside the resuscitation room, covered in blood, her face full of panic.

Zheng Ren hurried back to the Emergency Department, glanced at the patient on the bed, and a faint red diagnosis appeared in the upper‑right corner of the system panel: splenic rupture, hemorrhagic shock.

"The patient is a male, 45 years old, stabbed in the left upper abdomen an hour ago; when sent to our hospital his blood pressure was 80/60 mmHg." The on‑call doctor of Jizhen Wai Ke reported the history: "The emergency ultrasound showed fluid accumulation in the splenic fossa, depth 3.5 cm, with no fluid in the thoracic cavity."

Because the spleen lies beneath the left diaphragm, when trauma occurs one must determine whether there is a combined thoraco‑abdominal injury.

If a pneumothorax is present, once the patient is on the operating table and the ventilator keeps blowing… that could be fatal.

Although the system did not give a diagnosis of lung stab wound or traumatic pneumothorax, Zheng Ren still cautiously listened with a stethoscope. Breath sounds were clear in both lungs, with no dry or wet rales.

The trauma should be fairly simple.

"Where are the family members?" Zheng Ren asked.

"That's her." The on‑call surgeon pointed subtly at the woman standing stunned in the Emergency Resuscitation Room, saying, "Rumor has it the couple quarreled and she stabbed him directly."

"…"

That's so fierce?

However, Zheng Ren had no habit of getting involved in domestic disputes; he summoned the family, took the patient for another thoraco‑abdominal CT, confirmed there was no pneumothorax, and then went to the Emergency Operating Room.

Su Yun was already waiting at the door of the Operating Room; together with one of the Chu Family Sisters she pushed the patient inside, after which Zheng Ren went to change clothes.

The patient's condition was still okay; the injury wasn't severe, as could be seen from the blood pressure.

Perhaps a splenectomy could be avoided; Zheng Ren had a basic assessment of the condition in his mind.

After changing clothes, he scrubbed up and put on the surgical gown.

The Chu Family Sisters finished anesthesia; Su Yun had already completed the preparatory work—disinfection and laying the drapes—under the Shadowless Lamp everyone stood ready, waiting for Zheng Ren to step up.

It really felt like being a professor, yet Zheng Ren still wasn't used to this situation. In General Surgery Department One, Su Yun's work was always done by herself; sometimes she couldn't even get onto the operating table, and after laying out the instruments she'd be sent away.

All along he had been pondering the patient's condition, and Zheng Ren already had a plan in mind.

He reached out, and the handle of the scalpel was slapped into his hand.

Zheng Ren did not opt for a small incision; instead he took a 20‑cm‑long incision along the lower left rib margin.

In Xinglin Yuan, the live broadcast began.

【The great god hasn't done a live broadcast in a long time.】

【What is this this time? Huh? A rare splenic rupture.】

【It seems not difficult—just a simple splenic rupture, the blood pressure isn't very low, remove it and the patient can be discharged in a week.】

Following the habit in Xinglin Yuan of chatting a bit before watching, the doctors who entered first were making miscellaneous small talk.

For surgeons, a simple resection procedure indeed poses little difficulty.

Destruction is always easier than construction.

【What a big opening, truly spacious—I judge that it's not the same operator as before.】

【Who knows? The technique looks somewhat similar.】

【The moves are all fast, right? It's just a splenectomy; even if you wanted to go slow you couldn't drag it out much.】

In the live broadcast, the instant the peritoneum was opened, a gloved suction device was inserted, and thick dark‑red blood gushed out.

Soon the blood near the incision was sucked away; the suction device went further in, and the operator began opening the peritoneum and performing peritoneal protection.

【With an assistant, the surgery looks really easy.】

【Of course, otherwise how could there be a saying that surgery isn't done by one person.】

【Go look at the broadcaster's other surgeries—many are completed solo by one person. Adding one person only shortens the operation time by a few minutes.】

The doctors watching the broadcast have an inexplicable confidence in the operator, a confidence built up from dozens or even hundreds of previous surgeries.

After peritoneal protection, they entered the peritoneal cavity.

Su Yun held the suction device, aspirating the residual blood in the peritoneal cavity clean. At the same time Zheng Ren quickly examined the spleen and saw a knife wound about 2 cm on the upper pole of the spleen, with dark blood welling out.

He applied pressure with gauze to minimize bleeding, then Zheng Ren quickly inspected the liver, pancreas, stomach, blood vessels behind the peritoneum, nearby intestines, duodenum and other organs.

Fortunately, it was just a simple splenic rupture, matching the system's diagnosis.

Because the splenic rupture caused massive bleeding, the spleen had shrunk and was not adhered to surrounding tissue. Zheng Ren lifted the spleen out of the incision and carefully handed it to Su Yun.

【Wow, what is the operator going to do? Is he going to repair the spleen?】

【Probably yes; this patient is very suitable for splenic repair.】

【Except for a spleen too shattered to suture, we've already done repair procedures on all the others; splenectomy poses no difficulty at all.】

【Without bragging, can one die? Splenic repair surgery, one slip and the likelihood of returning to the table is extremely high.】

Regarding whether splenic rupture should be managed with repair or a violent resection, the many doctors watching the video each have their own judgment.

Hospitals or doctors with slightly weaker skills rarely dare to perform repair surgery.

Just like the patient who bled after Zheng Ren's partial nephrectomy a few days ago, the spleen also carries this risk.

Whether spleen or kidney, both are fragile; when suturing, if the tension is too low the wound won't hold, and if too high it tears instantly, causing secondary injury during surgery.

After Zheng Ren handed the spleen to Su Yun, he began to pad and press the splenic bed with large gauze.

The whole process looked quick, yet it was done carefully and cautiously, without causing secondary damage from rough handling.

While Zheng Ren was packing and pressing the splenic bed, Su Yun had already determined the direction and depth of the splenic laceration.

The wound was located at the upper pole of the spleen, about 3 cm deep.

After Zheng Ren finished packing the splenic bed, he reached out and took a needle with thread.

A medium‑sized needle, a standard 3# suture needle.

A fine thread, a 1‑0 absorbable suture.

Su Yun held the spleen steady, and Zheng Ren began a mattress suture.

【Uh…… why is it so fast? Isn't the operator afraid of tearing?】

It's probably because I'm more sure in my heart; having done it many times, I can't slow down even if I want to hurry.

It's really scary to watch; I've sutured a spleen before, and it tears apart as soon as I apply force.

This procedure is not routine; some surgeons at lower-level hospitals have never performed a spleen repair in their entire careers. Usually, when a spleen rupture is detected, they simply remove it to avoid the risk of a second operation post-surgery.

After suturing, Zheng Ren slapped the needle holder onto the patient's leg side; Xie Yiren then picked it up, placed it on the instrument tray, while wiping the blood off the needle holder and watching Zheng Ren's movements.

After tying the knot, Xie Yiren promptly slapped the scissors into Zheng Ren's outstretched hand.

Cut, suture, prepare warm saline for irrigation.

Proceed step by step, neither too slow nor too fast.