Chapter 353: 346 Accessory spleen?

346 Accessory spleen?

Because the family and the patient themselves reported no history of intimate contact, the most appropriate vaginal ultrasound could not be performed, so Zheng Ren could only do an abdominal ultrasound.

Although it was somewhat lacking, Zheng Ren had the system, this Big Pig Trotter.

However, the diagnosis given by the Big Pig Trotter this time made Zheng Ren dare not believe it.

Accessory spleen torsion……

This diagnosis…… if the patient had upper abdominal pain, Zheng Ren would have believed it immediately. But the patient had lower abdominal pain, so Zheng Ren cautiously prepared to do an ultrasound examination himself.

The uterus and both ovaries showed no abnormality; a mass about 5 cm in diameter could be seen beside the left ovary.

It seems the disagreement lies here.

Zheng Ren held the ultrasound probe in his right hand and pressed with his left hand on the patient's abdomen.

When pressing, Zheng Ren noticed that the mass was separated from the ovary, and inside could be seen several thick blood vessels.

Zheng Ren tended to agree with the opinion of the ultrasound room doctor, although on physical examination it looked very much like an ectopic pregnancy.

"Family?" Zheng Ren asked.

An anxious middle-aged woman stepped forward from the side and hurriedly asked, "Doctor, how is my daughter?"

"The source of the mass is unclear; Shou Bing exploration is needed." Zheng Ren, although he had a conclusion in mind, still cautiously used more general terms to describe it: "Prepare for hospitalization and Shou Bing."

The middle-aged woman's sweat poured down directly.

Ordinary people, upon hearing they need Shou Bing, who isn't afraid?

Stories of patients dying after appendectomy are widely circulated among everyone. Although the probability is low, it gives people a sense of fear toward Shou Bing.

"Chief Zheng, call me when Shou Bing is happening, and I'll come take a look." The Obstetrics Inpatient Chief, seeing that the emergency department had taken on this difficult case, felt very pleased.

But she was quite interested in the diagnosis; she did not think her own diagnosis was wrong, yet the ultrasound doctor's words also made sense, so she prepared to go see for herself.

Under normal circumstances, doctors most dislike exploratory laparotomy and thoracotomy, this type of Shou Bing.

Because once opened, nobody knows what the situation inside will be.

One needs rich clinical and Shou Bing experience to be able to resolve certain unexpected symptoms.

A little carelessness, and the consequences are hard to predict.

So the Obstetrics Inpatient Chief did not insist; after all, it's just exploration—if an ectopic pregnancy or similar condition is found, just treat it directly.

She followed along, not only to see what was going on, but also because she feared Zheng Ren lacked experience in performing ectopic pregnancy Shou Bing.

Now Zheng Ren, because of the medical disturbance incident, has high prestige in the Obstetrics Department; although the Obstetrics Inpatient Chief disagrees with some of his diagnoses, she still wants to back him up.

Zheng Ren, however, didn't mind; he nodded.

Today, Zhong Min from Internal Medicine is on duty; Zheng Ren, while walking, notified Yang Lei to come over for Shou Bing, and then summoned Chu Yan zhi.

He also didn't know how the Chu sisters' shifts were scheduled; anyway, calling either one would do.

Bringing the patient to Jizhenbingfang, they did preoperative preparations.

Zhong Min was responsible for receiving the patient, taking the medical history, and writing various documents; Zheng Ren seized the time to give the patient's family a preoperative briefing.

No matter what the diagnosis, it belongs to emergency care; time is very precious.

The patient's mother wiped her tears while signing her name on the Surgery Consent Form.

After signing, the nurse had already placed a gastric tube and a urinary catheter.

Yang Lei's home is a bit far; Zheng Ren directly, together with the patient's family, pushed the patient to the Operating Room.

When they arrived at the Operating Room, Chu Yan zhi had already arrived; several people worked together to move the patient onto the Operating table, and Zheng Ren went to change clothes.

Preoperative preparations inevitably take ten minutes, because the anesthesia procedure is rather cumbersome; Zheng Ren also wasn't particularly anxious.

Accessory spleen? Zheng Ren kept thinking about the diagnosis given by the system.

In embryology, an accessory spleen results from the failure of fusion of the splenic anlage located in the dorsal mesogastrium during the fifth week of embryonic development.

Clinical diagnosis is relatively difficult.

CT scans of accessory spleen usually show a smooth-edged, uniformly enhancing mass less than 2 cm. MRI scans can see a supplying artery originating from the splenic artery entering the accessory spleen.

Ultrasound can only serve as an adjunct; it cannot, like a Nuclear Magnetic Resonance plain scan, detect the branches of the splenic artery supplying Blood Vessels that enter possibly accessory spleen tissue.

Because the patient is an emergency case, there is neither time nor condition to complete various examinations; therefore, only exploratory laparotomy can be chosen to resolve it.

After changing into the Isolation Gown, Zheng Ren called the Medical Department and asked a colleague from pathology to work overtime.

If it were an accessory spleen in the upper abdomen, there would be no need for this.

But it occurred in the pelvis, very far away, with a possibility of tumor.

To rule out that the mass is neoplastic tissue supplied by a branch of the splenic artery, only a pathological diagnosis can confirm it.

This point, Zheng Ren had already explained in detail to the patient's mother.

Moreover, because this possibility exists, Zheng Ren cannot perform laparoscopic Shou Bing.

Because the small ports of laparoscopic Shou Bing cannot extract the accessory spleen; if it were smashed and removed, should it be neoplastic tissue, massive seeding metastasis would occur, directly advancing the tumor to an advanced stage.

After everything had been considered thoroughly, Zheng Ren came out of the changing room, called the Obstetrics Inpatient Chief, and began scrubbing his hands in preparation for Shou Bing.

Chu Yan zhi was lively and bouncing; the patient had already been anesthetized, and she was chatting with Xie Yiren.

Actually, saying they were chatting, it was mainly her speaking; Xie Yiren, while busily preparing Shou Bing instruments, was answering with murmurs of assent.

She asked Xie Yiren where he had gone, why he hadn't returned home, and such questions, not noticing at all the slight awkward silence between Xie Yiren and Zheng Ren.

A bold, straightforward girl, oh, she is completely opposite to Chu Yanran.

I don't know whether it's because, as identical twins, all the delicate thoughts have gone to Chu Yanran's side.

Yang Lei hadn't arrived yet; Zheng Ren didn't wait for him, finished scrubbing, directly disinfected, laid out sterile drapes, and prepared to open the abdomen.

Performing Shou Bing alone is no big deal; Zheng Ren had long been accustomed to it.

The Shadowless Lamp shone brightly; Zheng Ren glanced at the operative field, and considering the patient's age, he hesitated a moment, finally choosing an incision beside the left rectus abdominis near the lower mid-abdomen, about 8 cm long.

The incision is somewhat long, because during the operation they need to explore the source of the Blood Vessel.

If the incision is too small, we still need to extend it during the surgery.

Cut open the skin, then Blunt Dissection the subcutaneous tissue and fat all the way to the peritoneum.

The patient is relatively young, the fat layer is not thick, and Shou Bing is easy to perform.

At this moment, the Obstetrics Inpatient Chief rushed over.

Seeing Zheng Ren performing Shou Bing alone, she asked: "Chief Zheng, may I go up?"

"No need, Yang Lei will be here shortly." Zheng Ren applied a protective film, then directly opened the abdominal cavity.

Seeing the abdominal cavity opened, the Obstetrics Inpatient Chief also stopped talking and instead focused intently on watching Shou Bing.

The large Retractor pulled open the skin and muscle tissue of the lower abdomen, and Zheng Ren and the Obstetrics Inpatient Chief found the source of the patient's lower abdominal pain—a dark reddish soft tissue beside the ovary.

However, the dark red was somewhat deep, somewhat blackish.