Chapter 1200: Chapter 936: Where are You Hiding?_2 Chapter 1200: Chapter 936: Where are You Hiding?_2 Soon, the surface ultrasound was ready, and Yang Ping started to explore along the path of the aorta and its branches, sector by sector, searching for the ultrasonic image of the fish bone amidst the blood flow.
Yang Ping first examined the main trunk of the aorta, because the intraoperative surface ultrasound had to respect sterile principles, only examining the area not covered by the sterile drape, leaving other areas such as the abdon unchecked.
After the examination, no fish bone was found in the thoracic aorta or the abdominal aorta’s main trunk. The aorta branches off in many directions after leaving the heart, and these branches give rise to more branches. Having checked the main trunk, Yang Ping could only follow these branches to examine each supplied area one by one.
He had to look upward at the neck, the armpits, both upper limbs, and downward at abdominal cavity organs such as the liver, gallbladder, pancreas, spleen, and then the pelvic cavity, both lower limbs. In short, every area had to be investigated without omission, as the fish bone could end up in any potential location.
Fish bones perforating the esophagus and aorta are sowhat common, but traveling with the blood flow is very rare. Yang Ping clearly rembered that the vascular surgery departnt at West China Hospital once published an SCI paper reporting a case where a fish bone entered the aorta and then fled along the direction of the blood flow.
At that ti, the doctors could not find the fish bone after opening the chest and ultimately had to give up the surgery, letting the patient return to the ward for a new CT scan, which revealed the fish bone in the hepatic artery. After the patient had recovered and could withstand a second surgery, the doctors operated again, entering the abdominal cavity through the right costal margin, locating the hepatic artery by touch to find the fish bone’s position, and then cutting open the vessels to retrieve the fish bone.
However, it was obvious that this patient’s fish bone was not in the hepatic artery, as its shadow was nowhere to be seen throughout the entire abdominal cavity. Is it really necessary to give up on surgery and plan for a second one after a new CT?
Yang Ping was quite confident in his own skill with surface ultrasound, ruling out the possibility of a missed diagnosis on his part.
After completing the examination of the thoracic and abdominal cavities without finding the fish bone, Director Zhou grew even more anxious: “Should we do a full body CT scan to have a look?”
A CT scan would certainly be good, but if the fish bone could be detected with surface ultrasound, there wouldn’t be a need for such trouble, resolving the issue directly in the operating room would be much better than another surgery, at least reducing the patient’s surgical trauma.
“No need for such trouble!”
Yang Ping spoke with determination as he began to examine the neck and both upper limbs with the ultrasound probe. If the fish bone was lodged in a blood vessel, it would definitely affect the local state of blood flow, and this effect would be reflected on the ultrasound image.
With nothing found in both upper limbs, Director Zhou could no longer contain his impatience, but he hesitated to speak, fearing he might affect Yang Ping’s operation.
Since it wasn’t in the upper limbs, it was ti to check inside the skull. The probability of it getting there was extrely slim, but not non-existent. Yang Ping started a ticulous search through the vertebral arteries and the common carotid arteries upwards towards the cranial arteries.
Yang Ping’s eyes were fixed on the screen, ready to capture any minute changes on the ripple-like ultrasonic image, but unfortunately, the surface ultrasound of the cranium revealed no sign of the fish bone.
Yang Ping then completed the ultrasound of the lower limbs, which also showed no trace of the fish bone. Although combining surface ultrasound with the C-Arm machine wasn’t a hundred percent reliable in detection, it was close to that percentage, and with Yang Ping’s level of expertise, it shouldn’t be inferior to a full-body CT scan.
So where exactly had the fish bone gone? Had it simply not been found yet, or had it truly disappeared?
A two-centiter fish bone couldn’t have just vanished; it had to be sowhere, just not discovered yet.
At this point, Director Zhou was clearly unable to keep his composure, appearing agitated and restless, while Yang Ping remained very calm. After such a long period of tempering, Yang Ping had beco very calm, rational, and objective, with no significant emotional fluctuations during surgery.
“Should we push for a full-body CT scan?”
Once again, Director Zhou suggested, the seemingly only option left. It had to be done this way, otherwise what was to be done? The patient couldn’t just keep lying on the operating table indefinitely.
Yang Ping felt there was sothing peculiar about the situation. The fact that both the C-Arm machine and the surface ultrasound couldn’t track the trajectory of this fish bone was astounding. The fish bone was remarkable in its ability to hide, it seed improbable that it could conceal itself from him, raising the question of which part of the process had gone awry. Yang Ping thought about every step of the surgery, then deliberated all of the possibilities.
If the fish bone wasn’t in its original position, then it had to be in a nearby tissue, or inside the aorta or esophagus. If it had moved into the esophagus, it would have shifted to the stomach or intestines, but recent examinations with both surface ultrasound and the X-ray machine had found nothing.
If it ca down to it, the only resort was to conduct a full-body CT scan, yet Yang Ping still ticulously followed each step of the process in his search.
Thinking to himself, Yang Ping glanced at the basin on the floor where the gauze was being collected: “Patrolling, check all the gauze, one piece at a ti, to see if the fish bone has been caught on any of them.”
Could it be that while searching for the fishbone, it inadvertently ca out and was then taken away by the gauze, so now it’s not inside the patient? Yang Ping decided to first look around; if it truly wasn’t there, he’d then end the surgery, redo the CT-Scan, and schedule a second surgery for later.
The patrolling nurse and the intern began inspecting the gauze. The intern shone a flashlight while the patrolling nurse spread out each piece of gauze to carefully examine both sides. The two nurses worked together, ensuring no trace on the gauze, and then checked the gauze collecting basin—it was also empty.
“Has the liquid in the suction device been changed yet?” Yang Ping turned his attention to the inside of the suction device.
The nurse replied, “Not yet.”
“Filter all the liquid in the suction device through the gauze to see if it’s in there,” Yang Ping did not overlook the suction device either.
This gap, where the fishbone could be carried out of the body, represented a potential oversight. Without considering this, everyone’s thinking would be confined to the idea that the fishbone was still within the patient.
Although the fishbone was two centiters long, it was very fine, unbranched, and its arc wasn’t significant; it could have been entirely sucked up by the suction device. If it entered the suction device lengthwise, it would fit down the tube and into the suction bottle.
If the fishbone wasn’t in the suction bottle, then it definitely remained inside the patient. The only option would be to wrap up and deal with it later, with a new CT-Scan and a second surgery planned to retrieve the fishbone.
To be thorough, Yang Ping checked the suction heads and also had the nurse change and inspect the tubing. He instructed Director Zhou to check his gloves, the cloth removed earlier, and even the floor.
Now, with the fishbone missing, it was either inside or already out—a serious issue. The nurses dared not be negligent.
Thus, the two nurses began working in collaboration again. One held up a large piece of gauze as a filter while the other nurse slowly poured the liquid from the suction bottle onto the gauze for filtration, with the filtered liquid flowing into a collection bottle.
Director Zhou and the other doctors were already on edge, struggling to accept Yang Ping’s seemingly excessive behavior. But they dared not voice their concerns aloud and could only follow his orders.
It already seed excessive to inspect the gauze so ticulously, and now, not even sparing the filtered liquid in the suction bottle, he proceeded with filtration and examination—was it possible for the fishbone to be inadvertently sucked up?
Yang Ping remained composed. He executed his plan, determined to see it through whether or not the fishbone was found, as calling it quits now would complicate matters later.
If the fishbone was still inside, locating it with a CT-Scan would allow for its removal in a second surgery.
But what if, by then, a full-body CT-Scan revealed no fishbone? Leave it at that? Failure to detect it on the CT didn’t an the fishbone wasn’t inside. Would the patient have to live with a ticking ti bomb?
There was quite a lot of liquid in the suction bottle, nearly three thousand milliliters, and filtering it through gauze took so ti. The nurse, squatting on the ground, was very ticulous.
“The fishbone!”
A nurse exclaid excitedly.
The instruntal nurse instantly tossed so vascular clamps to that nurse, who then used them to pick up the fishbone and brought it over for Yang Ping and Director Zhou to see. Indeed, it was a fine, two-centiter-long fishbone, unbranched and intact.
No wonder it hadn’t been found; the suction device had suctioned it out.
“You can publish a paper on this case in SIC,” Yang Ping said with a smile.
There had already been a serious SCI article about a fishbone case at West China Hospital, and since finding this fishbone also required so effort, it was enough for writing an article.
Director Zhou couldn’t help feeling a chill of hindsight. If the fishbone hadn’t been found by Yang Ping, and the patient had been hastily concluded, was the fishbone removed or not?
What if it truly remained inside and the CT hadn’t found it? What then?
User Comments
0 comments from readers