The Surgeon’s Studio

Chapter 593: Complicated Gallbladder

“Hello, Chief Xia,” Zheng Ren said as he answered the phone.

Ever since he helped a few patients for the Gastroenterology Department, Chief Xia clearly recognized Zheng Ren’s abilities.

After that, whenever Chief Xia encountered a difficult problem, she habitually began to look for Zheng Ren to lend her a hand. Given her personality, it was very difficult for her to do so.

“Chief Zheng, I have a patient here. Can you help me take a look?” Chief Xia said.

Just as expected, but Zheng Ren did not mind. It was just to take a look. How much trouble could that be?

Moreover, as Zheng Ren’s skill tree progressed, he also needed to see more patients and accumulate more clinical experience.

After bidding goodbye to Zhong Min, who was on duty in the emergency ward, Zheng Ren headed to the Gastroenterology Department.

An emergency consultation required him to be there within five minutes. However, for a private consultation like that, there was no time limit at all. It was a favor after all. Since Chief Xia was not in a hurry, there was no need for Zheng Ren to rush over.

When he arrived at the Gastroenterology Department, Zheng Ren glanced at the doctor’s office. He did not see Chief Xia, so he went straight to the front door of the chief’s office and knocked on it.

“Chief Zheng, you’re here.” Chief Xia was reading the scans on the computer. When she saw Zheng Ren enter, she stood up and greeted him.

“Chief Xia, what’s the matter?” Zheng Ren asked.

“There’s this patient. I’m not sure about the diagnosis. I always feel that there’s something wrong. Help me take a look.” Chief Xia then pushed Zheng Ren to the desk and pointed at the CT scan of the upper abdomen on the screen, saying, “You’re good at reading scans. What’s this?”

Zheng Ren looked at the scans carefully. Chief Xia said, “The patient complained of intermittent right upper abdominal cramps and was hospitalized for seven months. The patient had an episode weekly, and each episode would hurt for one to three days. When the patient was in pain, there was no nausea, vomiting, fever, or jaundice. The most recent episode of abdominal pain was one month ago.”

“Okay.” Zheng Ren scrolled the mouse with his right hand. He looked at the scans frame by frame carefully as he asked.

“Before admission, there was an ultrasound.” Chief Xia was very familiar with her work. She was also very attentive to this problematic patient. She did not even need to look at the list for supplementary examination. She said casually, “The abdominal ultrasound showed that there was a fold in the upper and middle part of the gallbladder. There were no gallbladder stones and the gallbladder wall was slightly swollen. There was no dilation of the bile duct inside and outside the liver. The diameter of the common bile duct was about 3 mm.”

“Fold?” Zheng Ren muttered.

The gallbladder fold shown by the ultrasound was not a literal fold like an origami paper.

In clinical practice, gallbladder fold referred to the phenomenon of the gallbladder mucosa folding.

It was mostly seen in patients with chronic cholecystitis, but there were also some caused by congenital developmental abnormalities. If there were symptoms, it would be shown through the digestive system, for example, bloating.

Moreover, the patient’s gallbladder wall was slightly rough, so it could be diagnosed as cholecystitis.

“After admission, ceftriaxone was given as anti-inflammatory treatment. After ten days, the pain improved significantly but the upper abdominal CT showed stones.” Chief Xia frowned, feeling a little puzzled.

The patient’s symptoms had improved, so he should be able to leave the hospital.

Out of caution, Chief Xia checked his upper abdominal CT before the patient was discharged.

She did not expect the CT scan to show that the patient’s condition had not improved, but worsened instead! The inflammation had improved slightly, but a stone had appeared in the gallbladder.

However, the patient’s symptoms did not worsen. Instead, he was alive and well, clamoring to be discharged from the hospital.

It was not common for the patient’s self-reported symptoms to go against the clinical examination. They had to be extra cautious every time.

Zheng Ren looked at the CT scan of the upper abdomen frame by frame and stopped asking Chief Xia about the patient’s condition.

He had said what he needed to say. Nothing else was important.

Chief Xia noticed that Zheng Ren looked at the position where the gallbladder was folded for a few more seconds. Then, he continued going on to the other sections.

A few minutes later, Zheng Ren finished looking at the CT scan and said, “Chief Xia, the patient shouldn’t be diagnosed with cholecystitis.”

“Oh?” Chief Xia was stunned.

Overturn the original diagnosis? Was there a need to be so direct?

However, Chief Xia did not refute. She was ready to listen to Zheng Ren’s explanation.

Nevertheless, Zheng Ren did not provide an explanation. Instead, he stood up, smiled and said, “Let’s do an MRCP.”

“Do we need to?” Chief Xia was puzzled.

“Let’s go take a look at the patient. If my judgment is correct, this patient should be a rare double cholecystitis patient.”

Chief Xia was speechless.

“CT scans can only be used for guesses. It will be obvious once we do an MRCP.” Zheng Ren suddenly remembered something and asked, “Is the patient’s family financial situation alright?”

“It’s alright…” Chief Xia said.

“If the financial situation permits… forget it. We can also do a three-dimensional reconstruction while doing an MRCP. The patient doesn’t have any symptoms now. It’s better to do a more detailed examination so that we can decide how the surgery should be done,” Zheng Ren said, “The MRCP may have artifacts. It is impossible to determine whether the two gallbladder tubes will merge into the common bile duct after fusion or independently.

“After diagnosis, we can decide the operation method for the patient according to the classification of the gallbladder malformation Harlaftis depending on the variant being type 1 or type 2.”

Chief Xia was sweating.

The reason she looked for Zheng Ren was to determine why the patient’s upper abdominal pain symptoms had eased, but the examination found gallbladder stones instead.

She did not expect Zheng Ren to directly pull out the double gallbladder malformation out of nowhere.

Chief Xia almost vomited blood.

However, when she saw Zheng Ren being so sure, she also had some doubts.

Nevertheless, the problem was the double gallbladder deformity… even if Chief Xia was an old clinical chief, she had never seen it before.

When Zheng Ren noticed that Chief Xia did not move and did not have any intention of visiting the patient with him, he felt a little strange. However, he immediately came to a realization.

“Chief Xia, gallbladder stones have nothing to do with the double gallbladder deformity,” Zheng Ren said with a smile. “The patient’s gallbladder does indeed have sand-like stones. If the ceftriaxone is stopped, it will be fine in three to five days.”

“Huh?” Chief Xia was confused.

“After the application of ceftriaxone, reversible cholestasis occurs. The reason is that the calcium salt, the metabolite of ceftriaxone, enters the bile and easily settles in the gallbladder, acting as a “stone nucleus”, inducing gallstone disease,” Zheng Ren said, “If you don’t believe me, you can look at the instructions of ceftriaxone. There are complications in this regard.”

“Then… what exactly is wrong with this patient?” Department Chief Xia was confused.

“It’s a double gallbladder deformity, which is more serious. The silt-like gallbladder stones caused by ceftriaxone can disappear after a period of time after the drug is stopped. It is also known as drug-induced gallbladder stones.”

“Drug-induced gallstones?”

“For example, contraceptive pills, ceftriaxone, non-steroidal anti-inflammatory and analgesic drugs, intravenous high-nutrition drugs, and dipyridamole may all cause drug-induced gallstones,” Zheng Ren said.

“How did you know?” Department Chief Xia pressed on.

“From the surgery department. We once diagnosed gallstones, but after the operation, there was nothing in the gallbladder. In some cases, they would just let it slide. Meanwhile, in some other cases where the family would not let the matter rest, it would be treated as a medical accident. That’s why I have done more research in this area. ”

Department Chief Xia knew that Zheng Ren’s standard was not bad, but she did not expect his standard to be so high.

She picked up the phone and said, “Chief Zheng, please wait a moment, I’ll ask Chief Wang from the MRI Department.”