Chapter 22 Gastric perforation in the elderly, discussion of acute and severe cases
The old man's palms had a lot of dandruff falling off.
Some were white, some were red, and there were a lot of dead skin that had not fallen off completely.
"Are there any on the feet?" Xu Qiu asked immediately.
The old man was very surprised and said breathlessly: "Oh, yes. You are really capable!"
Xu Qiu hurriedly said: "Old man, you don't have to talk..."
His face became a little serious.
There are many diseases that cause peeling.
Like psoriasis, pityriasis rubra pilaris, pityriasis rosea, ichthyosis, etc.
However, only the palms and soles of the feet peel off, which is a symptom common in toxic shock!
And toxic shock...
Plus abdominal pain.
The most common ones are bacterial peritonitis, intestinal paralysis and gastrointestinal perforation!
Xu Qiu quickly listened to the patient's cardiopulmonary function.
In addition to the common manifestations of hypertension in the elderly...
There are no basic changes in cardiopulmonary function!
Auscultation of the abdomen.
Abdominal breathing sounds disappeared, and bowel sounds disappeared.
He wanted to check further, but the old man couldn't stay in bed because of severe pain, so he had to give up.
"The pain is burning.
Severe abdominal pain, nausea and vomiting.
The patient's temperature is also high, with fever.
In addition, the possibility of toxic shock...
Gastric perforation!"
Xu Qiu immediately came up with the most reasonable diagnosis.
He wrote a list of examinations and said, "Go for an abdominal plain film."
This is a diagnosis for gastric perforation.
"In addition, blood routine, coagulation, liver function, and kidney function were also done."
This is for toxic shock.
"Okay, let's go now!"
The young man wanted to carry his grandfather.
Xu Qiu stopped him and pointed to the corner of the clinic and said, "There is a folding wheelchair there."
"Okay! Thank you, doctor!"
The grandfather and grandson felt warm in their hearts and sat in the wheelchair and left.
"Next..."
Xu Qiu's voice sounded again.
...
...
More than three hours later, the grandfather and grandson came with a stack of examination reports.
They stood outside the door and waited for all the patients to leave before knocking on the door and coming in.
"Doctor, look!"
The young man had more respect for Xu Qiu.
All this was just because of a wheelchair.
Xu Qiu nodded and quickly scanned the checklist.
The plain film showed that the old man had free gas under his diaphragm.
A complete gastric perforation.
Other reports also indicated that the old man was infected.
There were mild abnormalities in coagulation, liver function and kidney function.
It is obvious that after gastric perforation, a large amount of gas and gastrointestinal fluid flowed into the abdominal cavity, causing bacterial peritonitis.
If the operation is not performed as soon as possible, the condition will develop into shock, and the old man cannot withstand this ordeal.
Xu Qiu put down the checklist and said solemnly: "Gastric perforation, prepare for hospitalization, and arrange surgery as soon as possible!"
"Listen to you!"
The grandfather and grandson had no doubts and quickly arranged for hospitalization.
On the same day, the old man completed all the examinations that should be done before the operation in the inpatient department.
Because the old man was older, the indicators of liver and kidney function, coagulation and other indicators were not optimistic, so the emergency department invited the gastroenterology department to consult.
At about three o'clock, the two departments discussed the surgical method for this case.
As the first doctor, Xu Qiu also participated in the discussion.
A doctor said: "There are two methods that have been determined.
One is to simply suture the perforation.
The other is to remove the majority of the stomach!
Everyone expresses their opinions and see which surgery is more suitable for personalized treatment of the patient!"
The deputy director of the Department of Gastroenterology frowned and said: "For this case, I suggest directly removing the majority of the stomach!"
He analyzed: "The patient has many perforations. There is a perforation of about 1.0 cm in the gastric antrum and the forearm of the gastric pyloric canal. In addition, there is also an ulcer perforation in the ileum!
If repair suture is performed, there are too many perforations to be treated!
Moreover, selective vagotomy plus pyloroplasty must be performed. The surgical steps are too complicated and the patient cannot last that long!"
A doctor agreed with this view and said:
"The patient is old, 78 years old. At this age... just remove the majority of the stomach."
Suturing is suitable for people with a longer survival period.
The old man is old. To put it bluntly, he will not live for a few years. It is very good to correct the peritonitis caused by the perforation.
It is obviously more practical to remove the majority of the stomach.
Just as everyone nodded in support, Xu Qiu's voice suddenly rang out.
He said calmly: "It is not a bad idea to simply suture the perforation..."
Everyone looked over.
The deputy director of the Department of Digestive Surgery became interested when he saw Xu Qiu, and said: "Tell me what you think."
Xu Qiu said: "The patient's physical condition is not as bad as everyone thinks.
When I examined him, I found that he just had a little high blood pressure. Apart from that, he was in good health.
His various abnormal indicators were basically caused by bacterial peritonitis!
If the majority of the stomach is removed, his quality of life will plummet in the future.
This is unacceptable for the patient.
Therefore, I recommend simply suturing the perforation!"
This view made many people frown.
A doctor said: "It is too difficult to repair and suture. There are seven or eight perforations in the image alone... Unless the operation can be completed within forty minutes!"
Everyone's eyes were cast on the deputy chief physician at the same time.
The deputy director shook his head: "It's difficult! If the abdominal cavity is opened, the situation will only be more complicated. There may be many small perforations that cannot be photographed!"
For such elderly patients, doctors tend to prefer conservative surgery.
The risk is too high, and the threat to career is even higher!
However, Xu Qiu took over everything at this time and said, "Leave this operation to me."
"You...?"
The faces of the digestive surgeons present suddenly became strange.
The emergency department asked them to come for consultation, isn't it because they can't solve it here and can only ask for help from specialists?
Their deputy director who specializes in digestive system diseases can't do it, Xu Qiu... can do it?
"I know you are very good at orthopedics and minimally invasive intervention, but digestive surgery is different from other departments... How about this, I will go to the operating table and you will learn from me?" The deputy director of digestive surgery said.
"Okay."
Agreed.
After the discussion, the deputy director and Xu Qiu went to talk to the patient.
When Xu Qiu introduced, the young man kept nodding without saying a word.
Finally, the deputy director added, "Make adjustments as soon as possible. When you are ready, I can start the operation right away."
The young man suddenly looked up and asked in confusion, "Isn't it Dr. Xu who will do the operation?"
The deputy director felt a little unhappy and said, "I am the deputy director of the Department of Digestive Surgery. I have performed at least a hundred operations of this kind. You don't have to worry..."
The young man ignored it.
He turned on his mobile phone and looked at the news on the public account of Linhai First Hospital.
"The surgeon who performed the operation on himself: Xu Qiu!"
"Young doctor mastered the difficult bone reconstruction operation!"
"Xu Qiu of the emergency department has achieved another success: conquered laparoscopic surgery in 37 minutes!"
"..."
Thinking of the wheelchair that represents care...
The young man's heart suddenly warmed.
He thought about it and said in a firm tone: "Can Dr. Xu do the operation?"
