Chapter 1746: with translation of chapter title

1686 Zheng Lao Ban, you sure missed me.

If it weren't for following the chief into Shou Bing and actually seeing the appendix being cut out, I really would have doubted it was an ectopic appendix.

I also don't know whether Zheng Lao Ban in Di Du has ever done this ectopic appendix; this kind of Shou Bing can be life‑threatening. Once you can't find it, that sense of helplessness on the Operating table is enough to make someone break down.

Found the tender point, only tenderness, no rebound pain or muscle tension.

Percussion was also standard. But there's nothing new; I do it too.

Auscultation…

After finishing the examination, Zheng Ren restored the patient's clothes and turned to leave the ward.

"Zheng Lao Ban, you…" Li Yong felt some tension.

He saw Zheng Ren's expression showing neither joy nor sorrow, as if victory was in hand, yet also as if he looked bewildered.

"Inject 5ml of methylene blue into the urinary catheter, then after 30 minutes draw abdominal cavity fluid." Zheng Ren gave the order while walking.

"Ah?" The young doctor was stunned.

"If you can see blue fluid when drawing abdominal fluid, that proves bladder rupture, possibly due to rupture of an old surgical scar." Zheng Ren said while walking.

"..."

"Zheng Lao Ban, this…" The young doctor felt somewhat incredulous.

"Young man, taking the history and conducting the examination must be thorough and careful."

The medical record shows that when the patient was admitted, the history taking, especially past history, was not detailed—for example, over 20 years ago the patient had a partial bladder resection for a bladder mass, which was omitted, resulting in missed diagnosis and mistreatment of an important disease. Zheng Ren said gently.

This young doctor, though relatively conscientious, had worked at the town‑level hospital for so long that many details were simply overlooked. Zheng Ren merely gave a friendly reminder, with no tone of reproach.

"During the first Appendectomy, intra‑operative findings did not match the diagnosis, the appendiceal inflammation was atypical, and the amount of fluid drawn was a bit large. Did you at the time consider whether it might be due to other causes?"

"No further exploration was done; as for whether there was a large amount of ascites during the Shou Bing, it's unknown, but we estimate there was already a small amount of urine at the time. However, it did not attract the surgeon's attention, or perhaps you all took the urine for exudate."

"…" The young doctor's face was drenched in sweat.

"Third, after using diuretics, the patient's abdominal distension markedly worsened. I remember you wrote this in the medical record; if you just thought one step further, you'd have reached the truth." Zheng Ren laughed.

"The patient's kidney function is fine; using diuretics, especially 40mg of furosemide, would produce 500—1000ml of urine output. But the urine drained via the catheter is pale yellow and hasn't increased—that's the biggest problem."

"In conclusion, I consider it bladder rupture. Hurry up and do the methylene blue test; if abdominal puncture draws blue fluid, transfer to Urology Department for Shou Bing. The Shou Bing isn't difficult—just suture it up."

"Zheng Lao Ban, really?" Li Yong still felt incredulous; seeing Zheng Ren's still somewhat immature face, he felt a bit lost in his heart.

"Huh? What's for real?" Zheng Ren didn't understand; he had explained it so meticulously and thoroughly—how could they not get it?

"I'll go right away." Seeing Zheng Ren about to leave, the young doctor summoned courage and asked: "Zheng Lao Ban, I… may I leave you a WeChat?"

"Huh?"

"In half an hour I'll do an abdominal puncture; if blue fluid appears, I'll report to you." The young doctor had a bright idea and found an excuse.

Zheng Ren smiled.

He took out his phone, opened the WeChat QR code for the young doctor, and they added each other on WeChat.

"You guys are busy; I'll go check on Old Liu." Saying that, Zheng Ren left on his own.

The medical and Shou Bing standards in Xilin Town are indeed those of a grassroots hospital—simple and rough; right lower abdominal pain equals appendicitis, with no consideration of other possibilities.

No differential diagnosis was performed; even if abnormal findings were seen intra‑operatively, they weren't handled. Post‑op… sigh, after using furosemide, urine output was low, kidney function was fine—such obvious points were overlooked.

Never mind, it's nothing to do with me; Zheng Ren walked out of the General Surgery Department ward and didn't think about it further.

For such a small case, Zheng Ren now basically doesn't need the Big Pig Trotter's System Panel. Just run through the history, look at the lab sheet and progress notes, and you can basically follow the clues to a conclusion.

The bladder rupture was obvious; the abdominal cavity fluid was urine. Zheng Ren finally consulted the Big Pig Trotter's System Panel and gave a definite answer.

As for the Shou Bing, simply suturing the bladder, Zheng Ren had no interest at all.

Besides needing a laparotomy, this Shou Bing's difficulty doesn't even match appendicitis. Moreover, rushing to the People's Hospital in Xilin Town to grab a Urology Department Shou Bing is a bit over the top.

Back in the ward, Zheng Ren chatted with Liu Xu zhi about Li Yong's lover's condition; Liu Xu zhi's lover came in carrying a lunch box.

She specially made Zheng Ren hand‑pulled noodles in hot broth; the noodles were especially chewy.

"Zheng Lao Ban, if we go to Di Du, Old Liu can't support the family, so I'm preparing to find a small noodle shop to work at," said Liu Xu zhi's lover.

"No worries," Zheng Ren laughed. "Nationwide, fewer than 500 people do Interventional surgery better than Old Liu."

500, that's a big number.

Actually Zheng Ren wanted to say 100, but that's only for TIPS Surgery. All things considered, 500 is a fairly standard figure.

As a doctor, being able to rank in the top 500 nationwide is solidly the level of a Team‑leading Professor at a provincial hospital.

Yet Old Liu's wife worried so much that Liu Xu zhi almost lost his life over thirty thousand yuan.

Saying it sounds quite absurd.

A handful of bitter tears.

Zheng Ren saw that Liu Xu zhi and his wife had already prepared for a do‑or‑die effort, so he didn't urge further. Going to Di Du, even if the level is high, one still has to work oneself to the bone.

Just lying down could keep one alive… it seems I can do that now.

A tenured professor at Massachusetts General Hospital, with a monthly salary of just over ten thousand US dollars, can easily enjoy life.

Tsk tsk, I hadn't even noticed I'd come this far so quickly.

Seeing that Liu Xu zhi's body was fine, Zheng Ren ate his noodles heartily, planning to have Feng Xu Hui book tickets after the meal and then hurry back to Di Du.

On this side of Xilin Town, Liu Xu zhi has been pulled back, and the matter is over.

After Old Liu rests a few days and brings the family to Di Du, we can then launch gastric fundus and left gastric artery embolization on a large scale.

I'll throw a few Shou Bing his way to see how much Old Liu can master.

His talent, Zheng Ren already had some understanding. Belongs to medium, this lifetime Liu Xu zhi can reach the height estimated will not exceed Su Yun Yan Yi's level.

But as a person, one cannot compare with Su Yun, right? Zheng Ren smiled.

Lao Liu estimated not too bad, after all himself pondering TIPS Surgery can touch the threshold, much stronger than most people.

The noodles not yet finished, a short and fat, sturdy person knocked on the door and came in.

He saw Zheng Ren, immediately showing a fawning smile, stretching out both hands and saying: "Zheng Lao Ban, you've made me miss you to death!"