Chapter 415: 407 Princess Disease (Part 1) (Six More Chapters Seeking Subscriptions)

He was just feeling emotional when the phone rang again.

The landline in the emergency ward is different from the one in Director Pan's office. When the director's landline rings, it's usually about administrative squabbles between hospital departments.

When the emergency ward's landline rings, it's most likely that the emergency department has sent a patient up, or they are unsure of the patient's condition and need Zheng Ren to consult.

He answered the phone, said a few words, stood up and headed downstairs.

"Boss, what's up?" Su Yun asked.

"Intestinal obstruction, a 15‑year‑old girl." Zheng Ren said.

"Come on, let's go take a look." Su Yun followed Zheng Ren, and the two went straight to the emergency department.

Intestinal obstruction is either due to intussusception in infancy causing the blockage, or due to reduced intestinal function in old age causing the blockage.

At 15 or 16 years old, when bodily functions are at their best, intestinal obstruction would appear—this is very rare.

Arriving at the emergency department, the internal medicine doctors were already swamped; the examination rooms were piled with people, most of whom were middle‑aged and elderly patients over 60.

That's how it is in the Northeast: young people with prospects, energy, or a specialized skill, and mid‑career technical backbone, mostly go work in the south. Those who remain are mainly the elderly.

This is a side effect of population loss, and it's just beginning; in the future it will become more severe. In hospitals, this shows up as fewer doctors and older patients.

Seeing Zheng Ren arrive, the emergency department's internal medicine doctor first comforted the elderly man in front of him, then hurried over to Zheng Ren, took him to the treatment room, and said while walking: "The patient is a 15‑year‑old girl who came to our hospital two days ago with abdominal pain and vomiting. On examination her abdomen was distended and soft to palpation, with diffuse tenderness but no rebound tenderness. The abdominal CT showed dilated bowel loops in the right side of the abdominal cavity and a large amount of fecaliths."

Her voice was a little hoarse; you could tell she had been speaking nonstop since she started work this morning, without even time to drink water.

"What treatment was given?" Zheng Ren asked.

"We gave a hypertonic saline enema, but it didn't work well." The emergency department internal medicine doctor replied: "After the enema, we took an upright abdominal flat film, which showed increased degree and number of dilated small bowel loops, plus an air‑fluid level."

"Hmm." Zheng Ren pondered.

Entering the treatment room, they saw a girl curled up on the treatment bench, retching violently but unable to bring anything up.

A middle‑aged woman, her face full of anxiety, wiped her tears while gently patting the girl's back.

"Chief Zheng, the images are here; take a look first, I'll get back to work." The emergency department doctor hurriedly gave Zheng Ren a few instructions, then rushed back to the consultation room.

Zheng Ren first went to the patient's side, had her lie flat with legs drawn up, rubbed his hands together to warm them slightly, then began the physical exam.

The patient was very thin, with long hair, big round eyes, long eyelashes, but her eyes were filled with tears—a natural reaction to violent vomiting, which Zheng Ren knew.

"What's your name?" Zheng Ren asked as a matter of course while beginning the physical exam; his hand was already placed on her left upper abdomen as he spoke.

"Brother, I'm Wang Yutong." The girl replied, blinking her big eyes.

"Are you in middle school or high school?" Zheng Ren asked off‑and‑on while his hand roamed over her abdomen.

The patient's upper abdomen wasn't markedly tender, but abdominal distension was typical; when he reached the lower left abdomen, tenderness appeared.

Zheng Ren searched carefully and confirmed the location.

The system panel's diagnosis read——intestinal obstruction, Larsen syndrome.

Zheng Ren felt a bit lost, but when faced with a problem he didn't understand—especially in front of the patient—he had to feign composure and confidence, which is a basic necessity.

After finishing the exam, Zheng Ren patted the girl's shoulder, signaling her to cover her belly.

He then went to the viewer and inserted the abdominal CT and the upright abdominal flat film.

Just as the emergency department doctor had said, these are typical signs of intestinal obstruction—whether fluid level or fecaliths, both are typical.

Zheng Ren fell into thought.

Su Yun noticed Zheng Ren's expression was odd, leaned in and whispered: "Boss, anything strange?"

"How much do you know about Larsen syndrome?" Zheng Ren asked.

Su Yun hadn't expected Zheng Ren to be consulting her; she thought he was testing her. She quickly searched her memory for information on Larsen syndrome.

As expected of a genius, her memory is absolutely flawless.

Like those historic figures whose names are recorded in the annals—whether it's glancing at a stele while riding by or remembering everything at a glance—Su Yun possesses all these abilities.

In just a dozen seconds, Su Yun retrieved the relevant information on Larsen syndrome from her memory.

"Larsen syndrome, also known as long‑haired princess syndrome, is a clinical condition first described by Vaughan Jr et al. in 1986. Patients have mild to severe trichotillomania and ingest the hair. The resulting hair bezoars enter the small intestine, causing abdominal pain, vomiting, nausea, malnutrition, hematochezia, diarrhea, and in severe cases intestinal obstruction." Su Yun whispered her reply, as if she were back in school with a venerable professor standing beside her.

"Testing myself? Such an easy question—how could I fail?" Su Yun felt a little smug.

"Hmm." Zheng Ren nodded after Su Yun finished speaking.

It matches the patient's symptoms almost perfectly. It looks like long‑term hair ingestion formed a fecalith that blocked the colon, causing the obstruction.

For an obstruction with a clear cause, the best approach is surgical removal.

Since everything's confirmed, let's prepare for surgery.

"Patient's family, come here a moment." Zheng Ren called out.

The patient's mother was caring for her, while the father followed Zheng Ren out of the treatment room.

"Does your daughter usually have any strange habits?" Zheng Ren asked.

The patient's father looked puzzled, tried to recall, but didn't know what Zheng Ren was asking about.

"It's fine if you don't know." Zheng Ren said gently: "I'm considering that the patient has intestinal obstruction symptoms; the films show a fecalith causing the blockage, and the enema didn't help, so we need surgery to relieve the obstruction."

Zheng Ren didn't directly explain Larsen syndrome to the patient's father—if he had, the father might have gotten angry right away.

Some things, the order matters.

Relieving the obstruction will ease the parents' anxiety; then, showing them the hairball and explaining the disease's origin and future treatment is the best approach.

The patient's father had no opinion either; whatever Zheng Ren said, went.

He called Su Yun, admitted the patient, made preoperative preparations, and went up to perform the surgery.

……

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