Chapter 909 - 450: Palpating the Intestines—Cutting Is Better Than Keeping

Chapter 909: Chapter 450: Palpating the Intestines—Cutting Is Better Than Keeping

Although the patient has a large amount of bloody exudate in the abdominal cavity and intestines, it is still somewhat different from massive hemorrhage.

Li Jingsheng believes that even at this point, there is still a possibility of rescuing the patient’s intestines.

As long as the diagnosis is correct and proactive measures are taken in advance, it’s a more effective approach. It’s definitely better than Director He simply opening the patient’s abdominal cavity, doing a basic heat application and drug treatment, and then closing it.

"Does Dr. Li think it is acute hemorrhagic necrotizing enteritis?"

Director He and his assistant asked almost in unison.

Neither of them had considered this disease.

They suspected that intestinal obstruction might be causing necrosis in segments of the small intestine.

"I am only suspecting this disease and cannot be certain."

Li Jingsheng’s diagnosis is quite daring.

To confirm this disease, the best method is a bowel pathology slice. Without pathological results, who would dare make a diagnosis?

Director He and his deputy chief physicians and attending physicians held an intraoperative consultation.

In the end, they remained undecided.

Half an hour later, they checked the effect of the heat application on the intestinal segment.

Parts of the intestinal segment were still not moving, but the color of the bowel was slightly more flushed than before.

This showed a glimmer of hope for Director He and others.

Li Jingsheng approached closely and carefully observed the patient’s intestinal segment. The circulating nurse kept a close eye on him, ready to object if needed.

In the operating room, the circulating nurse is like a tigress, regarding the whole OR as her territory.

She strictly controls all safety management and sterile operation procedures.

After checking, Li Jingsheng felt heavy-hearted.

Based on his surgical experience, although he couldn’t give a good surgical suggestion, the continuous inactivity of the bowel is a sign of bowel necrosis.

Or rather, necrosis has already begun.

"Xu Yan, call Director Bi to ask his opinion. Relate the situation here to him and see if he can offer a better solution."

He Qingzhi, uncertain of what to do, finally decided to consult Director Bi.

Shortly after, the circulating nurse returned after making the call.

"Director Bi’s opinion is to try to save the patient’s small intestine and listen to Dr. Li’s ideas as much as possible."

For the first time, she looked at Li Jingsheng with a surprised gaze.

Perhaps she was also surprised by Li Jingsheng’s high status in Director Bi’s eyes.

Not just her; even He Qingzhi’s subordinate doctors felt quite astonished.

Li Jingsheng’s participation in this surgery was primarily as a consultative physician.

To be honest, these doctors didn’t pay much attention to Li Jingsheng’s opinion.

Even the presiding Director He felt very conflicted.

Because he didn’t have a good plan and was undecided, he had to listen to a certain extent to Li Jingsheng’s opinion. However, Li Jingsheng’s opinion was not easily accepted.

For example, not long ago, Li Jingsheng raised the possibility of acute hemorrhagic necrotizing enteritis, which Director He did not agree with.

Li suggested doing a bowel pathology slice, which Director He was also not willing to agree to.

Ultimately, only after Li Jingsheng explained extensively and somewhat persistently did Director He reluctantly agree.

"Dr. Li, after the heat application, the patient’s bowel has turned a little pink, indicating there’s still hope. I’ve already discussed this with several doctors in the team, as you’ve heard. I plan not to do bowel resection, but instead an end ileostomy, followed by abdominal lavage and drainage, with direct closure of the abdomen. If the patient’s condition improves, his intestines can gradually recover.

What do you think?"

He Qingzhi had no choice but to seek Li Jingsheng’s opinion.

"I think this method is not advisable. The idea of saving the patient’s small intestine is commendable, but after heat application, some segments of the intestine still cannot move. If I were to say, these segments are quite likely necrotic.

Closing the abdomen after that, without timely treatment of necrotic segments, could directly affect other segments that may still be recoverable.

Moreover, the patient’s condition would worsen, and I’m unsure if there would be a third chance at an open surgery."

Li Jingsheng also knows that opposing Director He’s surgical suggestion in front of everyone is equivalent to going against him.

Before the abdomen was opened, he also considered end ileostomy, abdominal lavage, and drainage, which is a relatively safe conservative plan.

Now looking at the patient’s intestinal condition, Li Jingsheng finds this method unsuitable.

Because knowing the bowel might be necrotic and not cutting it out is akin to spotting a spark and ignoring it. In the end, it turns into a raging fire. At that point, trying to control it is already too late and unprofitable.

Rather than this, it’s better to remove the evidently necrotic segments now.

"Then let’s continue with the heat application and see for a while. If it doesn’t work, we’ll think of another solution."

Director He, having a different opinion and now hearing Director Bi’s statement to heed more of Li Jingsheng’s advice.

He dared not act alone.

Having no choice, he opted to observe for a little longer.

Time slowly passes.

Keeping the patient’s abdomen open, the heat application on the intestines continues.

Everyone is eager for a miracle.

The color of the bowel becoming slightly flushed is clearly a good change.

Now, as long as the heat application induces intestinal movement, even slight movement, it would be enough to uplift all medical staff.

During the waiting period, another thorough discussion ensued on the patient’s condition and the treatment plan.

Li Jingsheng still believes that if the intestines cannot show movement, it’s very dangerous.

Another hour has passed, checking the condition of the warmed intestines.

The color of the intestines is still the same, slightly turning a bit rosy, but still not moving.

This made everyone feel disappointed.

"Dr. Li, do we have to cut the patient’s intestines?"

Director He asked unwillingly.

"Circulating nurse, after I wash and disinfect my hands, can I feel the patient’s intestines?"

Li Jingsheng did not answer immediately but looked at the circulating nurse.

"Why?"

The circulating nurse looked puzzled.

"Maybe I can feel its vitality through touching the intestines, thus devising a treatment plan better suited for the patient."

Li Jingsheng provided a reason.

"This..." The circulating nurse found it a bit outrageous, she looked at Director He.

In the operating room, the person who truly holds the authority is the chief surgeon.

Or rather, everyone is a team, serving the patient.

Whether it’s the anesthesiologist, the chief surgeon, or the circulating nurse, they should all be equal in status.

But wherever there are people, there is a hierarchy.

The chief surgeon holds the highest status, there is no doubt about that.

"Can Dr. Li really judge the vitality by touching the intestines?"

Director He, being a chief surgeon himself and not lacking in surgical skills, should have a profound understanding of touch.

"I can’t say for sure. How should I put it, it’s like your understanding of the feel of the scalpel during surgery. You can perceive the depth of the cut and which tissue you’re cutting. I can only say, it’s worth a try."

Li Jingsheng responded.

"Then give it a try! Everything is for the patient. As long as it’s beneficial for the patient, I support it."

Director He agreed.

Li Jingsheng washed his hands, disinfected them, and then tried to feel the patient’s intestines.

First, he felt the normal section of the intestines.

After that, he moved to feel the diseased section of the small intestine, doing it very carefully this time.

He even closed his eyes to obtain a better sense of touch.

Vision and touch sometimes conflict with each other.

Because visual impact is stronger, it can easily overshadow some tactile sensations.

By closing his eyes, he effectively shut off his vision, thus obtaining a clearer sense of touch.

After careful discernment, he found that there’s a section in the middle of the ileum that has basically lost all vitality. The main judgment basis includes the intestinal movement and the blood flow in the intestinal vessels.

This section is mostly necrotic.

Besides this, there are two small sections of the ileum nearby showing similar necrotic signs.

The remaining diseased sections of the intestine still have some issues but aren’t as severe.

[Intestinal Diagnosis +1, Health Points +1000].

An unconventional touch diagnosis surprisingly earned him a large reward of one thousand health points.

This gave Li Jingsheng more confidence in his diagnosis.

"Director He, I’ve finished feeling it. I suggest you directly remove this section of the ileum from the patient and then perform an anastomosis. Also, there’s another issue; this section, though seemingly alive, is much weaker than the normal sections. I’m not sure if it will affect the result of the anastomosis?"

Li Jingsheng seriously offered his suggestion.

"The patient’s small intestine is severely diseased, it will definitely impact the anastomosis. But I still have confidence. However, the long section of ileum you mentioned, is it really necrotic and must be removed?"

Director He asked.

"Yes, I am very certain that its vitality is gone. Removing it is far better than not."

Li Jingsheng nodded seriously.

After all, the low status leaves him with little authority in the operating room.

If he were the chief surgeon, he wouldn’t need to explain so much.

Once the accurate diagnosis is made, it could be cut directly.

That day may take some time to come, but it won’t be too long.

Because he already has his own medical team now.

Although it’s still very rudimentary, totaling only four people, two of whom were practically dragged in by him to make up the numbers.

But it doesn’t hinder Li Jingsheng’s growth.

As long as he can continue receiving colonoscopy examinations, his team can stabilize and gradually develop.

"Alright then, I’ll trust you! Because indeed, this section of intestine hasn’t moved. Your words broke my last bit of false hope, maybe it’s not a bad thing."

After hearing this, Director He decided to remove that section of the intestine from the patient.

"Even if this large section of the intestine is removed, whether the rest can be saved is still unknown. But there is at least some hope." Li Jingsheng believes removing this section of the intestine is definitely the correct choice.