Recently, a 31-year-old young female patient was successfully resuscitated in the Department of Interventional Vascular Surgery of Peking University First Hospital due to large mesenteric vein thrombosis, secondary to intestinal necrosis, abdominal and intestinal hemorrhage, and infectious toxic shock. When the patient’s parents and loved ones expressed their gratitude to the medical staff with their 8-year-old daughter, Dr. Zhang Xiansheng, deputy director of the Interventional Vascular Surgery Department, said, “It was the trust of the patient and your family that supported our confidence in overcoming the disease at the critical moment, and it took mutual trust and reliance between the doctor and the patient to forge a bloodbath and rebirth again.”
At present, this patient has safely passed the dangerous period and transferred back to the general ward to continue treatment.
Patient with sudden onset of severe abdominal pain and vomiting At 10:00 on January 18, a 31-year-old female patient from Tangshan, Hebei Province, Xiao Zhang was admitted to Beida Hospital for emergency interventional vascular surgery due to severe abdominal pain, vomiting, blood in the stool and abdominal distension. She Kang, the chief resident of the ward, immediately took a detailed medical history and conducted a careful physical examination. Xiao Zhang suddenly developed severe abdominal pain, which was persistent but not exactly localized. He had been repeatedly given the analgesic drug Dulcolax with no effect, accompanied by obvious abdominal distension, frequent nausea and vomiting, and fresh blood stool. On physical examination, Zhang was found to be irritable, with a temperature of 39.5 degrees, respiration of 30 breaths/min, heart rate of 155 breaths/min, blood pressure of 70/40 mmHg, abdominal pressure, rebound pain and muscle tension. The laboratory report: hemoglobin 100g/L, platelets 112*10^9/L. Zhang Xiansheng, Yin Jie, She Kang, and Chenggong discussed the condition and considered Xiao Zhang to have acute superior mesenteric vein thrombosis, secondary mesenteric and intestinal necrotic bleeding, and infectious toxic shock. The results of laboratory tests reported that Xiao Zhang’s hemoglobin dropped rapidly along with diffuse intravascular coagulation, and within a few hours his hemoglobin had decreased from 100 g/L to 50 g/L, and his platelets rapidly decreased from 112*10^9/L to 22*10^9/L. If surgical treatment was not performed in time, Xiao Zhang would soon die.
Present at the time of the presentation of the condition were Xiao Zhang’s lover and his parents-in-law. The mother-in-law said: “Although this child is my daughter-in-law, but married to our family is like their own daughter, we have been to several hospitals, know the danger of the condition, we have explained the condition with her parents, do not worry! Do your best to resuscitate her, even if you can’t bring her back to life, our family thanks you for your diligent and active efforts to save her.”
Looking at the falling blood pressure on the monitor, Deputy Director Zhang Xiansheng decided to operate immediately, “Despite the difficulties and huge risks, we will do our best to save the young life and her simple and kind family.
The anesthesia team led by Dr. Li Chunqing, deputy chief of the Department of Anesthesiology, quickly corrected the circulatory failure and started the precise anesthesia. Doctors Zhang Xiansheng, Yin Jie and Chenggong started the operation for the patient. Xiao Zhang’s condition was more serious than predicted before surgery, not only the scope of intestinal necrosis was large, involving the entire transverse colon and mesentery, but also part of the ascending colon and ileus, while there was a large amount of blood accumulation in the intestinal cavity, high tension, and severe edema of the intestinal wall along with The whole body coagulation function was severely disturbed, and the situation was extremely dangerous.
The surgical team worked in their own way, and Zhang Xiansheng and the medical staff on the operating table worked closely together to remove the thrombus in the mesenteric vessels, free the necrotic intestinal collaterals, suture the mesenteric root vessels, cut off the intestinal canal and cut off the source of infection in only 20 minutes. Meanwhile, anesthesiologists Li Chunqing and He Shuting actively dilated, rehydrated and elevated the pressure to stabilize Xiao Zhang’s circulatory status. Offstage, traveling nurses Zhu LaMei and Dr. She Kang repeatedly contacted the transfusion department to send intraoperative laboratory tests and borrow resuscitation drugs. The nurses in the ward also closely cooperated with the resuscitation on the stage. In the bitter cold wind, bags of life-saving blood were sent from the transfusion department to the operating room.
Because of the diffuse intravascular coagulation and severe coagulation dysfunction, Zhang had a large area of blood oozing from the wound, and the operation was once unusually difficult. During the operation, Xiao Zhang’s face was pale, his lips were cyanotic, and he was in a state of severe anemia. The blood flowing from the table was pink like meat washing water, and he had to rely on blood pressure-raising drugs to barely maintain his blood pressure, and his hemoglobin was at a minimum of 40g/L after blood transfusion. Zhang Xiansheng and the surgical team made accurate and gentle sutures to stop bleeding at every bleeding point, and after suturing one by one, repeatedly checked all the surgical fields to ensure that no hidden dangers were left. The anesthesia team also quickly and accurately applied drugs to maintain Xiao Zhang’s stable signs and correct coagulation disorders during the operation. After nearly 5 hours of emergency resuscitation, Xiao Zhang’s massive bleeding and shock were finally reversed, and all vital signs gradually showed a stable state. The tacit cooperation of all medical and nursing staff and several departments finally pulled Xiao Zhang back from the death line.
Family trust is the biggest support Talking about the race with death, Zhang Xiansheng, deputy director of vascular surgery, who has many experiences in dealing with critical illnesses, said, “This is a medical miracle, and the cooperation and support of the family gave us the greatest confidence.” During resuscitation and surgery, the family was very understanding and cooperative with the doctors. In today’s news of doctor-patient conflicts, such understanding and trust is an invisible power, and the medical staff and family members rely on each other’s trust to keep even death at bay.
Information link: According to She Kang, mesenteric vein thrombosis is one of the most misdiagnosed surgical emergencies due to its insidious onset and atypical symptoms. In most cases, the definitive diagnosis is obtained only during open exploration. The early misdiagnosis rate of acute mesenteric vein thrombosis is as high as 90%, and when intestinal necrosis occurs, it can progress to multi-organ insufficiency and systemic inflammatory response syndrome within a short period of time, with a mortality rate of 50-90%.