Recently, I treated two consecutive patients with small intestinal fistulas, both of which were severe. The first one was cured and discharged, but every step of her treatment is something I will never forget.
Both patients had their own characteristics, the first one was heavily infected with abdominal cavity and had severe peritonitis when she was transferred to our hospital, but after reasonable and effective drainage and flushing, her symptoms improved day by day. This patient is much more complicated than the last one because this patient has portal vein trunk thrombosis, splenomegaly, and a high empty-field fistula located 10 cm from the beginning of the jejunum, where intestinal blood flow is a problem. At the same time, this patient had a right-sided subdiaphragmatic effusion and lower abdominal effusion, which were prepared for treatment on Sunday. The common features of both patients are the maintenance of water-electrolyte balance and the prevention of deep vein catheter-related infections. Strangely enough, both patients have two “magic circles” or “weird circles” where untimely management can lead to death or organ insufficiency. The first one is that within a week the patient’s condition will improve and then severe water-electrolyte disturbance will occur again, the patient’s mental state will turn rapidly, heart rate will rise, shortness of breath and other critical symptoms will gradually improve after a day or so of intense treatment. The second is about half a month due to deep vein catheter infection caused by the patient’s high fever, my respected teacher Ren Jianan director advised us to use the deep vein as little as possible, but this kind of patients need to make up high concentration of electrolytes, I can not do anything ah, so the second magic world is entangled, if out of these two magic world, and then control the patient’s abdominal infection and organ function, the patient will be almost done. Wang Feng, Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University
I’ve been working on the night shift today, and because of this patient with jejuno-enteric fistula, I’ve been in the ward during the day and dealing with other patients, so I’m tired at night. Fortunately, there is a bright sword spirit taught by Prof. Ren Jian’an, otherwise I would really not be able to hold on, persistence is victory. After the wind and rain to become a real fistula warrior!