Come on, Dr. Wu

Chapter 419 Difficulties
"Hello, Director Wu."

The patient's husband did not let himself stay too long. His concern for his wife surpassed everything else. He hurried to greet Wu Xiaofu. His eyes were filled with expectations and even pleadings. After so many days, how could he not understand his wife's illness?

Even Chen Zhendong was helpless. It was obvious that his wife's illness was not a simple one.

If even Wu Xiaofu cannot be treated, they will probably just have to wander in despair. After all, this is the best hospital in Donghai and even in the whole country.

So, Wu Xiaofu is really their savior.

Wu Xiaofu nodded to the patient's husband, walked up to the patient and checked his condition.

The conjunctivae are pale, the skin of the limbs is wrinkled, the skin is loose, and the joints are deformed.

Pale conjunctiva is caused by anemia. The patient has bleeding, so it is understandable that the conjunctiva is pale. However, the changes in the skin and joints make people think more.

Looking at the patient's abdomen, the abdominal condition was actually fine. Except for tenderness in the right upper abdomen, there were basically no other abnormalities. No masses were palpable in the abdomen, nor was there any negative shifting dullness.

"Director Wu, what is wrong with me?"

The patients were also looking at Wu Xiaofu with expectation at this time, wanting to get an answer. They had also received higher education and knew that coming to the hospital for treatment might not be really difficult if the disease was difficult to treat, but if they didn't even know what the disease was, then it would be really difficult.

The patient's husband was also looking at Wu Xiaofu. Seeing that Wu Xiaofu's expression did not change, Chen Zhendong felt confident that as long as Wu Xiaofu didn't frown, he would be confident.

Then he thought again, yes, after so long, it seems that he has never seen a disease that Wu Xiaofu cannot cure.

"Boss, do you have an answer?"

Wu Xiaofu nodded and said, "I have seen a case before, it was from abroad.

The patient in that case was an old lady who also experienced discomfort in the left lower back and weakness in the left lower limb without any cause and went to see a doctor. That patient's condition was much more serious than hers.

He was also suffering from hypovolemic shock at the time. After arriving at the emergency room, the doctor was not given much time to examine him and had to be treated directly.

An abdominal CT scan was performed at that time, which also showed a left retroperitoneal hematoma. Therefore, the first attending physician did not dare to delay and performed an emergency stent implantation on the patient while correcting the shock.

A 16×70mm GORE EXCLUDER peritoneal stent was gently placed in the left external iliac artery, and the patient's blood pressure dropped to 50/30mmHg.

DSA showed that the patient's left external iliac artery was ruptured at the distal end, so the second 12×100mm GORE EXCLUDER peritoneal stent was gently placed at the distal end of the left external iliac artery.

However, arterial blood pressure continued to drop to 39/27 mmHg, and DSA indicated that the blood vessel distal to the second stent ruptured again.

Therefore, the third 12×100mm GORE EXCLUDER peritoneal stent was placed following the second one. Unfortunately, angiography showed that the bleeding had spread to the left popliteal artery, and the treatment ultimately failed.

After hearing the unfortunate news, the patient's daughter also felt discomfort in her lower back and after an emergency CT scan, it was revealed that she had a right-side retroperitoneal hematoma, so the patient's daughter was also admitted to the ICU.

What was even more complicated was that the patient’s daughter was lying on the bed where her mother had died a few hours earlier. The attentive nurse considered that this might make the patient feel psychologically uncomfortable, so she later changed her room. Fortunately, with the old woman’s experience and lessons, the daughter was successfully discharged after conservative treatment.”

This!
Chen Zhendong broke out in a cold sweat when he heard this. Not only Chen Zhendong, but Zhao Xin, who was standing at the door at this time, was even more frightened and broke out in a cold sweat when he heard Wu Xiaofu's words.

Although Wu Xiaofu did not explicitly state what the patient's illness was, they had already realized the danger of the disease, and vascular fragility was probably beyond their understanding.

Fortunately, Zhao Xin was only conducting an exploratory examination at the time and did not find any bleeding, so he did not perform any interventional treatment. Otherwise, it is very likely that the patient would have followed in the footsteps of the old woman described by Wu Xiaofu.

But the result is different again.

The old lady Wu Xiaofu mentioned was abroad, but the young patient in front of them was in China. The medical environment was different, especially since the patient was only 26 years old. If there was really any life-threatening danger, Chen Zhendong and Zhao Xin couldn't imagine it.

Not to mention what happened afterwards, if such a young life was lost because of their mistake, they would probably find it difficult to forgive themselves.

The patient and her husband obviously did not understand the meaning of the case described by Wu Xiaofu. They just looked at Wu Xiaofu, wanting to hear the next step.

Chen Zhendong has already spoken, "Boss, what kind of disease is this?"

They are all professionals and have thought more. From the case Wu Xiaofu mentioned, the old woman and her daughter might have the same disease and are related by blood, so it might not be a genetic disease.

However, once genetic factors are involved, diagnosis and treatment are not so easy.

Chen Zhendong actually had some doubts before. After all, when asking about the medical history, the patient also talked about his previous condition, as well as the condition of the patient's older sister. In fact, now that he thinks about it, he's afraid that it might not be the same condition as the patient.

Rupture of abdominal aortic aneurysm may also be due to the existence of this genetic factor.

Related genetic diseases flashed through my mind, but genetic diseases are complicated, and many have not yet been fully studied. It is even more difficult to determine what the disease is based on these.

Especially for those who study surgery, genetic diseases are not a major subject they deal with, so their knowledge reserves are even smaller. It is extremely difficult to find the corresponding genetic disease for the patient from these complicated genetic diseases.

“Have you ever heard of Ehlers-Danlos syndrome?”

Ehlers-Danlos syndrome!
Chen Zhendong thought hard after hearing this. This ranking sounded so familiar, but he really couldn't remember it for a moment. However, Zhao Xin behind him suddenly remembered something.

Ehlers-Danlos syndrome, also known as "excessive skin elasticity syndrome.

This disease has not actually been fully studied. We only know that people who suffer from this disease will have symptoms such as weight loss, translucent skin, easy rupture of blood vessels, easy skin abrasions, easy dislocation of joints, and facial features.

There are many subtypes of Ehlers-Danlos syndrome, and the cause of death is often due to aneurysm rupture and bleeding. Misdiagnosis and invasive examinations and treatments can easily worsen the condition or even lead to death. Conservative treatment is the first choice for this disease.”

The reason why Zhao Xin was able to think of Ehlers-Danlos syndrome first was not because he had much more knowledge than Chen Zhendong, but because everyone has their own expertise. Zhao Xin was an interventionalist, and he had to remember all the diseases that would be fatal if treated with intervention.

However, Ehlers-Danlos syndrome is so rare that Zhao Xin has basically never seen it since he started working. When he took notes, he just glanced at it a few times.

If I were to see a doctor, I'm afraid I really wouldn't be able to remember it.

If Wu Xiaofu hadn't suddenly revealed the answer, he probably wouldn't have been able to remember it. Thinking of this, Zhao Xin was even more frightened.

As an interventional doctor, if he really killed a patient due to his own negligence, he would feel guilty for the rest of his life. Moreover, this is different from the reason that led him to stop practicing medicine.

Last time, he had a clear conscience, but this time, if he really caused the patient to get hurt, he would feel guilty.

Listening to Zhao Xin's words, Chen Zhendong's mood was not much better than Zhao Xin's. He was even more relieved in his heart. Fortunately, Wu Xiaofu came back and fortunately Wu Xiaofu had a backup.

Otherwise, he would have to perform an abdominal exploratory operation. Given the characteristics of Ehlers-Danlos syndrome, once the abdomen is opened, it would be difficult to close it again.

There is a high probability that the patient's operation will fail because of ruptured blood vessels and difficulty in healing.

Once the blood vessels of such patients rupture, it is difficult to anastomose or ligate them because they are too fragile.

For patients with Ehlers-Danlos syndrome, even if the doctors are the most experienced and skilled, the success rate of surgery will not exceed half.

"this!"

The patient's family members were also shocked when they heard this, especially the patient who suddenly thought of his sister, whose abdominal aortic aneurysm ruptured, was exactly the same as what Wu Xiaofu and the others had said.

"But Director Wu, what should we do? We can't have surgery, so we have to use conservative treatment. It's been a week, and the blood is still not enough. We have to keep replenishing it. We can't keep going like this."

The patient's husband had a bitter look on his face. On the one hand, he felt sorry for his wife, and on the other hand, he really couldn't bear it anymore.

Is this blood that is lost? It is money that is lost.

The money spent on blood transfusions every day is enough to drag down their family. If this is the only way it can go on, the patient’s husband dares not imagine his future life.

He also didn't want his wife to suffer the pain of surgery, but thinking that it would be a permanent solution, he gritted his teeth and agreed, and was waiting for Chen Zhendong to perform the surgery. Who would have thought that even surgery is a luxury now.

Not only was the patient's husband puzzled, but even Chen Zhendong and Zhao Xin were also in a dilemma at this time. The patient's problem now was liver bleeding. Although the intervention could not find the bleeding site, the bleeding must have existed. Otherwise, how could such a large hematoma be formed?

So, now patients are faced with two problems that need to be solved.

One is the most urgent bleeding problem now, and the other is the hematoma on the patient's liver.

The presence of hematoma will affect liver function, and now they suspect that the patient's bleeding area may be covered by the hematoma. Originally, Chen Zhendong was thinking of relying on drug treatment to see if the hematoma on the patient's liver can be absorbed.

But after a few days, it seemed that the hematoma not only did not absorb, but also continued to grow.

If this continues, the possibility of liver necrosis cannot be ruled out.

Therefore, simply using internal medicine medications may not be able to solve the patient's problem at all. If internal medicine medications cannot solve the problem, and surgical operations cannot be used, then this is a dead end.

But when he met Wu Xiaofu's eyes that had not changed, Chen Zhendong's heart moved again.

"Boss, do you have a solution?"

Facing everyone's hopeful gazes, Wu Xiaofu smiled and nodded, "If nothing unexpected happens, the bleeding area of ​​the patient should be surrounded by the hematoma. What matters now is to remove the hematoma in the patient's liver and let the bleeding area heal as soon as possible."

Well, everyone nodded when they heard this, "But that's the problem. We can't have surgery now, we can only use medication. We have tried medication for several days and it doesn't work. I'm afraid this way won't work."

"Who said I can't have surgery?"

Ah!
Everyone was stunned after hearing Wu Xiaofu’s words. Wasn’t it you who said that?

No, it’s about avoiding surgery as much as possible, not that surgery is not possible. Also, this is not what Wu Xiaofu said, this is what they said.

"However, the patient's blood vessels are so fragile that the risk of risky surgery is too great. After the operation, I'm afraid the subsequent healing will be a big problem. Even if you have superb skills, these objective problems are always unavoidable."

Chen Zhendong said, indeed, this is an objective problem. Wu Xiaofu was about to say something, but Zhao Xin spoke first, "Boss, do you want to intervene?"

Because Wu Xiaofu's main focus is surgical operations, people always subconsciously ignore the fact that Wu Xiaofu is also an interventional expert. However, Zhao Xin will not ignore this fact. He has witnessed Wu Xiaofu's interventional abilities with his own eyes, and even he feels inferior to him.

"However, intervention has strict requirements on the patient's vascular conditions. If the guidewire enters the blood vessels, given the patient's current vascular conditions, the patient's artery may rupture if not careful. Zhao Xin was lucky that he did not cause bleeding last time. If an interventional surgery is performed again, no one can guarantee the consequences.

Moreover, Zhao Xin did not move the blood vessels last time, but this time is different. The patient's hematoma must be adhered to the blood vessels. Clearing the hematoma will inevitably affect the blood vessels, which may cause heavy bleeding if not careful. Moreover, even if the hematoma is cleared, it will be difficult to anastomose the bleeding area of ​​the patient.

Given the patient's current vascular condition, even touching the anastomosis would be very risky, let alone anastomosis."

Zhao Xin nodded when he heard this. Chen Zhendong was right. This was also the reason why he did not dare to insist on interventional surgery after Wu Xiaofu pointed out that the patient was suffering from Ehlers-Danlos syndrome.

However, everyone's attention was still focused on Wu Xiaofu.

What they were talking about were objective problems, but they knew even more that Wu Xiaofu never spoke without a purpose. Since Wu Xiaofu had already said that he wanted to intervene, there must be a way. They were now very curious about what way Wu Xiaofu had to solve these objective problems.

Facing everyone's gaze, Wu Xiaofu did not keep anyone in suspense.

"For the same interventional surgery, this time we use a thinner guide wire to enter the blood vessel, and we must not touch the blood vessel wall. We use a drug balloon to deliver drugs to the hematoma site to remove the hematoma. After the hematoma is removed, we use drugs to quickly heal the bleeding site."

This!
There are drugs for clearing hematomas, and there are also drugs that can make bleeding areas heal quickly. These are all available, but the problem lies in how to deliver these drugs to the liver. Wu Xiaofu did not mention the risks involved at all.

This is not a question of whether the guide wire is thin or not. It is that no one dares to say that they will not touch the blood vessel wall during interventional surgery. The blood vessel wall is elastic. During normal interventional surgery, many doctors will use the elastic conditions of the blood vessel wall to determine the position.

Therefore, touching is inevitable. That is a guide wire, not your own fingers, and you cannot control it at all.

(End of this chapter)