Chapter 763: 751 Three Solutions

Seeing Zheng Ren still holding his chin and looking at the films, Shen Boshi gave a bitter smile.

Zheng Lao Ban really is a technique dog, his interpersonal communication ability is just ridiculously weak.

At this moment, you shouldn't be politely greeting Director Luo and stating your purpose—who the hell asked you to come view the films?

Zheng Ren didn't speak, and Shen Boshi couldn't do anything either, so he had to grit his teeth and go ahead.

"Director Luo, no no……" Shen Boshi waved his hand, saying: "I came accompanying Zheng Lao Ban."

"……" Director Luo was stunned for a moment.

Zheng Lao Ban? Whose is he?

Director Luo glanced at Zheng Ren, boss? Could he be referring to this bruised-faced little guy? He must be a businessman's boss, probably a second-generation rich.

Old Kong is really out of line, bringing a doctor's subordinate, a clueless second-generation rich, here to do what? Simply…… He was somewhat displeased, glancing at Shen Boshi.

Shen Boshi sensed the emotion in Director Luo's gaze, knowing he definitely couldn't resolve this matter himself, so he grabbed Zheng Ren's sleeve and shouted at him.

"Ah?" Zheng Ren, after reconstructing the film, compared it with countless related cases from magazines and journals in the System Library, already having a plan in mind.

"Zheng Lao Ban, please speak." Shen Boshi said softly.

"Uh……" Zheng Ren only then realized what had happened, he cursed himself inwardly, really having no sense of proportion.

Originally coming to the gastroenterology department to pay respects, he stood there foolishly dazed—this is trying to show off but ending up exposing his butt.

"Director Luo, sorry, I got lost in looking at the films." Zheng Ren performed a Jiu Gong, striving to show a faint smile, saying.

With the progress of technical skill, unconsciously, Zheng Ren's demeanor also made a leap.

Using the gaze of a mature senior physician to examine medical-related matters, even when facing Director Luo of the 912 Gastroenterology Department, Zheng Ren's attitude lacked the timidity of a junior doctor, instead carrying a confidence imbued with humility.

"Oh?" Director Luo found this little guy somewhat interesting.

Coming to ask him for help, although he performed a Jiu Gong and spoke, his tone lacked even a trace of humility and fear.

Either it's the fearlessness of the ignorant, or there's something else going on.

"Oh? What did you see?" Director Luo also didn't take the film away, give it to the patient's family, and let them leave. He looked at Zheng Ren and asked leisurely.

"Frames 17 to 19 have a problem." Zheng Ren said.

Director Luo's brows furrowed slightly; this bruised-faced little doctor was correct, the problematic frames were indeed those few.

What showed up on the image was not obvious; figuring it out was quite difficult, and the patient's prefecture-level hospital also didn't give a correct diagnosis.

Was he just guessing?

"Continue." Director Luo found the matter increasingly interesting, he said lightly.

"Director Luo's diagnosis is fine, I'll add two sentences." Zheng Ren stared at the film, saying: "Has the patient ever had Crohn's disease?"

The patient's family looked at each other, shaking their heads.

One of them looked at Zheng Ren with some annoyance; if not in Director Luo's office, he would surely point at Zheng Ren's nose and curse a few times.

Getting the diagnosis wrong, what are you pretending to be a big-tailed wolf for?!

Zheng Ren caught a glimpse of the patient's family's expression and immediately knew what was going on.

"Oh, Crohn's disease, also called Crohn's disease, formerly called Crohn's disease in old surgical books, I'm used to it. Was it treated with oral mesalazine for a period, then stopped?" Zheng Ren didn't think much of it, saying.

Upon hearing mesalazine, the patient's family froze.

"How did you figure out the patient took oral mesalazine?" Director Luo suddenly found this bruised-faced little doctor interesting, so he asked.

"There are traces left after ulcer healing." Zheng Ren looked at this difficult film, opened dual-mode, thinking while answering: "After oral prednisone and mesalazine, Crohn's disease was controlled, but after stopping the drug there would be relapse."

Director Luo curiously looked at Zheng Ren; this young guy's film-reading level is indeed not bad. The film indeed shows the linear traces formed after ulcer healing in Crohn's disease, but it's especially atypical, requiring a high film-reading level to notice.

"Why oral prednisone?" Director Luo posed the question.

"A pelvic CT can show part of the femoral head, already exhibiting early symptoms of ischemic necrosis. Cross-referencing with other conditions, considering the patient was being treated for Crohn's disease, long-term oral hormone therapy caused this. Usually combined with mesalazine, it's prednisone." Zheng Ren spoke fluently, not showing weakness, with reason and evidence.

Director Luo nodded and said: "Continue."

"The image from this film suggests a non-polypoid colorectal tumor. Unlike polypoid colorectal tumors, this type usually does not protrude into the intestinal lumen, being flat or slightly raised. The vascular morphology is blurred, allowing observation of uneven erythema and irregular nodules."

This sentence directly pointed to the problem; Director Luo's impression of Zheng Ren was immediately revised.

Generally, besides doctors who are very professional at reading films, few people can determine from a single CT scan that the vascular morphology is blurred, with uneven erythema and irregular nodules.

In other words, abdominal CT usually only examines solid organs; for examining the intestinal tract, most of the time a gastrointestinal endoscope is used.

The local doctors gave the patient an abdominal plain CT scan, presumably to check for tumors. A quick glance showed no large tumor, so they skipped it.

But who would have thought that such a simple film would be seen through by Director Luo and Zheng Ren at the 912?

Director Luo was also curious; being able to see it is only natural. This is the 912, one of the nation's top-tier tertiary hospitals; if he couldn't see it, that would be strange.

But this bruised-faced little guy could also see it, giving an analysis with reason and evidence, not just guessing—this makes sense.

"What do you think should be done?" Director Luo asked, his finger tapping the back of his hand a bit faster.

"There are three solutions: one preserves more intestine, requiring postoperative regular colonoscope checks for new tumor growth; the second involves a colostomy, which would affect the patient's quality of life; I relatively recommend the third, total colectomy with ileorectal anastomosis, in which case only regular rectal checks are needed post‑operation."

Zheng Ren, from the perspective of a general surgeon, gave the patient's family three options and provided his considered best solution.

There were a few sentences; Zheng Ren said them simply, the patient's family didn't understand, but Director Luo knew what Zheng Ren meant—surgical removal of the diseased intestine and postoperative follow‑up observation.

He pondered for a moment, then said: "The third solution can be considered, but it's still safer to first do a colonoscope biopsy."

……

……

Looking at the book review section, a reader asked about Crohn's disease, so I found a case and wrote it up. I don't know how to treat it……