Chapter 346: Accessory Spleen?
As the family and the patient had denied any past sexual contact, Zheng Ren could not suggest a transvaginal ultrasound and instead, settled for an abdominal ultrasound.
Although it was not as suitable, Zheng Ren had the System on his side.
Zheng Ren had trouble believing the System’s diagnosis was true.
An accessory spleen torsion…
This diagnosis… If the patient was experiencing upper abdominal pain, Zheng Ren would take the System’s word for it. However, the patient was hurting in the lower abdomen. Therefore, he decided to perform the ultrasound.
The uterus and the two ovaries showed no abnormalities. There was a lump next to the left ovary, approximately 5cm wide.
The doctors’ disagreements lied there.
Zheng Ren held the ultrasound scanner in his right hand while his left hand depressed the patient’s abdomen.
When he exerted pressure, he noticed the lump moved away from the ovary and the area between the two masses showed large blood vessels.
Zheng Ren was leaning toward the sonographer’s diagnosis but understood why the chief resident suspected an ectopic pregnancy.
“Where’s the family?” Zheng Ren asked.
An anxious, middle-aged woman approached him. “Doctor, how is my daughter?”
“We’ll have to perform a surgical procedure to find out the tumor’s roots.” Despite having the System’s diagnosis, Zheng Ren spoke in rather general terms to avoid trouble. “Let’s begin the admission and surgery prep.”
Sweat dripped from the middle-aged woman’s forehead.
Most people were not keen on surgery.
Jokes of appendectomy patients dying post-surgery were constantly on people’s minds. The probability of it happening was low but was still present.
“Chief Zheng, ring me when you start the surgery. I want to have a look,” the gynecology chief resident said. She was excited to have encountered a tricky case.
She was confident in her diagnosis but the sonographer’s observation made sense. Hence, she wanted to have a closer look.
In general, doctors hated exploratory laparotomies.
There were too many unknowns as no one knew what laid inside the patient’s body.
It required a doctor with sufficient clinical and surgical experience to solve the unknown as a misstep could be fatal.
The gynecology chief resident was fine with the exploratory laparotomy. If a gynecological problem was identified, they could fix it there and then.
There was another reason she was keeping tabs on the case. She was worried Zheng Ren had never done an ectopic pregnancy surgery.
Zheng Ren’s reputation in the gynecology department had been on the rise ever since he had successfully handled the medical dispute. While the chief resident did not agree with some of Zheng Ren’s views, she refrained from challenging him outright.
Zheng Ren did not mind the extra pair of eyes. He nodded at the chief resident.
Zhong Min was on duty today. Zheng Ren made a call to Yang Lei and then Chu Yanzhi to inform them of the surgery.
To be honest, Zheng Ren was not sure how the twins had split their duties but either one was enough.
He brought the patient to the emergency ward for the presurgical preparation.
Zhong Min was responsible for getting the patient settled and documenting all their details and history. While she busied herself with the patient, Zheng Ren took the time to explain the procedure to the family.
Regardless of which diagnosis was correct, time was of the essence.
The patient’s mother was wiping tears from her eyes as she signed the informed consent documents.
The gastric catheter and urinary catheter were all set up as soon as the signing was complete.
Yang Lei stayed a distance away from the hospital, so Zheng Ren wheeled the patient to the operating room with her family’s assistance.
Once inside, Chu Yanzhi had arrived. A few staff worked together to move the patient onto the operating table while Zheng Ren went off to change.
There would be approximately ten minutes before Zheng Ren would be needed inside. The anesthesia for this case was tricky so he took his time.
Accessory spleen? Zheng Ren mulled over the System’s diagnosis.
Based on tissue biology, the existence of the accessory spleen was due to the failed fusion of the original spleen buds located in the dorsal mesangial membrane of the stomach during the fifth week of embryo development.
It was hard to diagnose in practice.
In CT scans, the accessory spleen was a mass less than 2cm in diameter with a smooth outline and even contrast. An MRI would show a feeder artery that branched from the splenic artery to supply nutrients to the accessory spleen.
A B-scan ultrasonography was rudimentary. It could not clearly visualize the branching of arteries in the abdomen.
As the patient came in through the emergency department, there was no time to arrange for the various scans. An exploratory laparotomy was the only solution.
Once changed, Zheng Ren called for a pathologist’s consult.
If the accessory spleen was in the upper abdomen, Zheng Ren would not have worried.
However, it was in the pelvic cavity. There was a chance of it being cancerous.
In order to rule out cancer, a histological sample would be required.
Zheng Ren had informed the patient’s mother on the particulars.
Due to this possibility, Zheng Ren opted for a laparotomy instead of a laparoscopy.
The small incisions made in a laparoscopic procedure were too small to retrieve the accessory spleen. If the mass was damaged during retrieval and happened to be cancerous, metastasis could occur en masse, leading to late-stage cancer.
The surgical procedure was decided after a thorough risk assessment. Zheng Ren informed the gynecology chief resident of the surgery, then proceeded to scrub in.
Chu Yanzhi was bouncing on her feet while the patient lay sedated. She was chatting with Xie Yiren.
Well, chatting was not the right term. It was more like Chu Yanzhi was talking at Xie Yiren as she prepared the surgical tools. Xie Yiren’s replies came in the form of affirmative noises.
Chu Yanzhi was asking about Xie Yiren’s absence at home. She did not notice the awkward silence from Xie Yiren and Zheng Ren.
The total opposite from her sister, Chu Yanzhi spoke in a direct manner, oblivious of the room’s mood.
Chu Yanran had gotten all the tact and attentiveness.
Yang Lei was still nowhere to be found. Unwilling to wait, Zheng Ren began the disinfection process and laid down the surgical drapes.
A solo surgery was nothing new to him.
The surgical lamp illuminated the area before him. He studied the surgical site. The patient was young and to minimize scarring, he made an 8cm incision down the left flank of the rectus abdominis.
The incision was long as he had to investigate the blood supply’s source.
If the incision was too small, he would have to extend the cut midway through surgery.
The layers beneath the skin were parted carefully.
The young patient had less adipose tissue which made the surgery easier.
At this point, the gynecology department’s chief resident arrived.
She saw Zheng Ren alone at the operating table and asked, “Chief Zheng, do you need my assistance?”
“No, Yang Lei should be here soon.” Zheng Ren gently manipulated the peritoneum and accessed the cavity.
Seeing the exposed abdominal cavity, the chief resident stopped talking and paid close attention to the ongoing surgery.
A retractor held the skin and muscles of the lower abdomen at bay. Zheng Ren and the gynecology chief resident saw the culprit—a visible mass sat right beside the ovary.
The redness of the mass was almost black.