At 11 o’clock, on duty.
The phone suddenly sounded, and the side of the phone was a hurry of a junior high school classmate. He said that his wife had a sudden stomach pain, which was very painful and painful. What to do.
I asked about which position pain and when did it start to hurt. The old classmate said that it was about 10:30. It was painful in the right lower abdomen. At first, it was just a bit painful, and now it is getting more and more painful.
My heart is estimated that the lower right abdominal pain should be caused by appendicitis and ureteral stones, because in the night shift acute abdomen, these two diseases contribute at least 80%of emergency outpatient cases. Of courseBroken, ectopic pregnancy rupture, etc. These cases also encountered from time to time.
My old classmate came to the hospital immediately and went directly to the emergency department. I needed to check to make a diagnosis. I could not diagnose any disease on the phone.
The old classmate lived in the city. He drove the car and rushed to the hospital in 15 minutes.
I went to the hospital’s parking lot to pick him up while I had no emergency patients.When I saw his wife, I was very painful, and my mouth kept shouting "good pain, painful pain" all -body clothes were soaked by sweat, her face was pale, and her road could not go. Even the voice was weak and weak.
Looking a bit like kidney colic, I have seen too much about this scene.In order to rush, I did not go to the emergency clotter, and directly asked the old classmates to rush to the emergency department.
Dr. Zhou, a deputy chief -level physician in the emergency department.
When Dr. Zhou saw the patient, he simply asked what the situation was. After learning that it was abdominal pain, he immediately gave the nurse’s oral doctor’s order, and first hung a bottle of salt water to the patient to absorb oxygen.This is an example of the emergency department. For the severe symptoms, open the venous channel first, and at the same time infusion supplement the blood capacity. In case of rescue, you can use the medication as soon as possible, because some patients need to do an needle after finding the blood vessels and need to get an needle after shocking the blood vessels.For a long time, the best time to rescue the best rescue.
Dr. Zhou began to ask the medical history while checking.
Where is the first pain position?Dr. Zhou asked.
It hurts here from the beginning.The patient pointed at the right lower abdomen.
Dr. Zhou stabbed the abdomen with his hands, from the upper abdomen to the lower abdomen.In the upper abdomen and left and lower abdomen, the patient does not have obvious tenderness points. When the right lower abdomen, the patient feels obvious pain, but there is no obvious reflex pain.Delive -shaped belly.
After the abdominal strike, Dr. Zhou was actually chaotic.Because according to the symptoms and signs of the current manifestation, the diseases in his thinking are not obviously worthy.
The lower right abdominal pain, the first thought of the appendicitis, the pain of appendicitis is characterized by metastatic right lower abdominal pain, that is, the upper abdomen disease in the early stages of the onset, and it was transferred to the right lower abdominal pain after a period of time.The patient was manifested at the beginning of the right lower abdomen pain, and some of the typical appendicitis could also be manifested as the right lower abdominal pain at the beginning. This is the past, but one thing is not supported by this diagnosis.Very violent, the pain of general appendicitis does not reach this level. Unless appendicitis is perforated, it causes severe peritonitis, but the patient’s abdomen is soft, no plate -shaped abdomen, and no reflux pain, and does not support peritonitis.
From the perspective of the patient’s pain, it is more like renal colic caused by ureteral stones, because some kidney colic can stun the pain.But the tenderness point of the abdomen of the ureteral stones does not seem to be so obvious.
In terms of gynecology, luteal rupture, ectopic pregnancy rupture, and ovarian cyst twisting can also cause severe pain in the lower abdomen. This requires examination to identify.
Dr. Zhou also asked the patient’s holiday situation. The answer was that the menstruation was just two days, and the menstrual flow was almost the same as the month.
Dr. Zhou quickly flashed the name of the disease.
The gastrointestinal and duodenal perforation, the inflow of the digestive solution, can also cause severe pain in the lower abdomen.
Paraceward inflammation of the gallbladder, gallbladder perforation, and the lower abdomen pain in the lower abdomen.
But the most basic signs of the abdomen: rebound pain, no.The symptoms of primary lesions in the abdomen are not obvious.
Hepatoma rupture, necrotic pancreatitis, myocardial infarction, twisted narrow hernia, aorta clay layer, and intestinal cases are basically excluded one by one.
Dr. Zhou suddenly remembered that a patient had been diagnosed ten years ago. It was a local intestinal necrosis caused by the intestinal membrane arterial embolism, which was somewhat similar to the patient’s symptoms.
There are also intestinal obstruction caused by intestinal tumors, intestinal adhesion intestinal obstruction, intestinal torsional ischemic intestinal necrosis, and is very similar to the symptoms in front of the eyes. Although most of the intestinal reversal occurs on the elderly, it cannot completely exclude this.Possibility.
Dr. Zhou thought of the possible disease names, and he was still not sure in his heart. In any case, he had to check it.
Dr. Zhou told his general thoughts to his old classmates.The old classmates said that they need to do whatever check. They listen to the doctor and do not need to consider the cost of expenses.
Dr. Zhou took out his doctor: abdomen, urology, gynecology, abdominal cavity, appendix color Doppler ultrasound, electrocardiogram, abdominal CT, blood routine, blood amylase.
Quickly pull the bed to the color ultrasound. Due to the special condition, Dr. Zhou may have no bottom, so I followed the B -ultrasound room. I checked it in order.
There is no tumor in the liver, excluding tumors to destroy bleeding.
The gallbladder is well filled, and the gallbladder wall is not thick.
The size of the pancreas is normal and the echo is uniform, and pancreatitis does not support pancreatitis.
The kidney does not detect stones, the kidney has no accumulated water, and the bilateral ureter has not been expanded. It can originally exclude the possibility of ureteral stones. Although some ureteral stones and ureter are not expanded and the kidneys are not accumulated, it is rare. For the time beingThis possibility.
The uterus is not large, the endometrium is not thick, only 5mm.Pregnancy is not supported, because even if the uterine is pregnant, the uterus will increase slightly, and the endometrium will be thickened to more than 10mm.
The bilateral ovarian is clear, the blood flow is normal, the pelvic cavity has no effusion, and the ovarian has no cystic structure. It can further exclude ectopic pregnancy. It can also exclude luteal rupture and ovarian twist.
The right lower abdomen appendic area was cleaned, and there was no obvious low echo structure or mixed block, and appendicitis could be basically eliminated.It can only be said that it is basically excluded, because a small number of people in the backdrop and abnormal appendix, B ultrasound cannot be found.
Only the abdominal cavity is not checked. Because the abdominal cavity is disturbed by the intestinal qi, it is difficult to observe even if there are any problems. This is a blind spot for B -ultrasound.
In fact, I, including Dr. Zhou, have been hairy in my heart, the inspection is almost over, and I have not found a positive symbol.Doctors are most afraid of unclear diagnosis. If the diagnosis is clear, the doctors of the vegetables know how to deal with it, and they can basically solve the problem if they do not help turning their medical books.
I looked at the abdominal cavity from top to bottom, and slowly checked from left to right: there was no abdominal effusion, and no intestinal block was found.
When there was no matter how to do it, I suddenly found that some intestines in the right lower abdomen were slightly expanded, and the inner was a liquid dark area.
This is really a problem. Although it is not as obvious as the whole intestinal expansion as the typical intestinal obstruction, it is also a positive signs.
Intestinal expansion B -ultrasound
I communicated with Dr. Zhou next to me. At present, only a series of examinations may be a little bit of illness, but it is not typical. It is just a slight expansion of the intestine.Those who cause intestinal dilatation effusion must be obstructive somewhere in the intestinal cavity. As for whether it is caused by tumors or caused by intestinal twisting or other reasons, the B -ultrasound cannot be identified.
I can only move to the CT room immediately to see what CT can find.
However, the results of the CT come out, and the intestinal cavity is only prompted to expand the effusion of the intestinal cavity.Similar to the B -ultrasound results, there is no new valuable diagnosis.
Intestinal expansion abdomen CT diagram
But in any case, the cause is focused on the intestinal obstruction, and now it is just looking for the cause of obstruction.
After returning to the emergency department, because the patient’s abdominal pain was too severe, Dr. Zhou opened a voche multi -needle for muscle injection. The pain was slightly relieved, and it was just a little relieved. The pain was still very severe.
Dr. Zhou, who contacted the duty doctor of the general surgery, went down to consult. Tonight, the general surgery was Dr. Fang’s duty, and it was also an old doctor with more than ten years of work experience.
After checking the body quickly, Dr. Fang looked at various test results and put forward opinions: From the perspective of the patient’s symptoms and test results, the main consideration is currently considering intestinal obstruction, and the intestinal tube may have ischemia and necrosis in order to occur.Pain.It just caused the cause of obstruction and failed.Surgeons are actually afraid of patients with abdominal pain. Some causes are complicated. You go on with a knife, sometimes you ca n’t find the cause, and you will be closed by the abdomen and return.It should not be late, and immediately turn to surgery, and you must have a caesarean section at any time.
After getting up to the surgery, the gastrointestinal tube was inserted to give gastrointestinal decompression, and it was aware of spasm and painkillers. The patient’s pain could not be relieved.
Whether it was an immediately surgery or observing for a while, Dr. Fang also couldn’t get an idea. He called the director of the department to report the condition.
Director Huang arrived in less than 10 minutes. After doing a detailed medical examination and completing all reports, he proposed that the patient’s continuous severe abdominal pain may have intestinal ischemia and necrosis.The content of the intestinal content leaked out the abdominal cavity, which is extremely easy to cause a large area of abdominal cavity infection, which causes sensitive shock. At that time, it will become very tricky, and the patient will be dead at any time.
Moreover, the patients have cold limbs, indifferent expressions, and shock symptoms such as shock (blood pressure dropped to 90/60mmHg) such as shock symptoms, and it is even more dangerous to develop.
So you must surgery immediately: Caesarean section detection
As for the intestinal twisting or adhesive intestinal obstruction (Director Huang found scarring scar during the body, it does not rule out this possibility), it will be clear.
With the director’s filming, it is unobstructed later.
Sub -surgical notification form, family signed, nurses prepare skin.EssenceEssenceAt about 40:00 in the morning, the operating room was received.
Director Huang personally fled himself, Dr. Li, a doctor on duty, became an assistant.
The operation was smooth and resolved the battle for two hours.
The first time after the operation, I learned about the situation during the operation, and the cause really made you unexpected.
It turned out that a semi -ring adhesive band formed on the outside of the uterus after a caesarean section, and then a period of colon was squeezed in, causing a narrow intestinal obstruction.There are about 15cm intestinal tube.The development of narrow intestinal obstruction must be developed rapidly. The patient developed from 10:30 pm to the start of the operation for two hours.Thin, it looks like a transparent balloon, and it will rupture at any time. Once ruptured, it will inevitably cause infectious shock.Fortunately, your classmates are delivered in time. If you delay for another 1 or 2 hours, the consequences are unimaginable and there is danger of life at any time.
10 days after the operation, the patient was discharged smoothly.
My old classmate got married early. The younger son was 18 years old and studied in high school. He didn’t want the adhesive band caused by cesarean section 18 years ago, but it has a big problem today.
I asked my old classmates for the cause of the disease. A few days before the onset of the disease, in order to lose weight, his wife did not know where to learn the tricks. Every day, he rubbed his stomach desperately. Presumably, he squeezed the intestines into the adhesive belt.
It seems that everything must be caused.