The Enhanced Doctor-Chapter 566: Ectopic pregnancy

"Banxia, why is the situation so tense this time? The blood transfusion has already started, and the blood type results just came in," Wang Lei said after Liu Banxia entered the operating room.

"Ah... because of her pregnancy, I didn’t do an X-ray. I’m not sure if it’s an intestinal perforation causing a mesenteric artery rupture. Hopefully, it’s not too late," Liu Banxia said in a grave voice.

"We need to be fast after opening the abdomen. The blood pressure is stable now, but there will definitely be massive bleeding once we open up," Wang Lei reminded him.

Even though he knew Liu Banxia would have considered this, he still felt the need to remind him. He knew Liu Banxia was conflicted about operating on a pregnant patient and was worried he might make a mistake under pressure.

Once the abdomen was opened, fresh blood gushed from the incision.

"Suction! Help me find the bleeder! Increase the transfusion volume," Liu Banxia ordered. After speaking, he began examining the patient’s intestines.

"The intestines are intact. Check the liver, aorta, arteriae rectae, and inferior vena cava."

After inspecting the intestines, beads of sweat began to appear on Liu Banxia’s brow.

A misdiagnosis. The patient wasn’t suffering from a rupture due to intestinal obstruction. So now, he needed to perform a detailed examination inside the abdominal cavity to figure out which blood vessel was the problem.

Perhaps the pain in the patient’s lower right abdomen was referred pain, a misdirection. It might even be an aortic aneurysm or an arterial dissection.

"Teacher Liu, I can’t find the source of the bleeding!" Xu Yino said, becoming somewhat flustered as she watched blood continue to pool in the abdominal cavity.

They had inspected all the common bleeding sites in the abdominal cavity, and everything seemed intact. But now the blood was gushing again. What do we do now?

"Banxia, you need to hurry. Her blood pressure is dropping rather quickly," Wang Lei reminded him.

Liu Banxia clenched his teeth, his mind racing.

The patient’s unique condition was her pregnancy. It couldn’t be an issue within the uterus; its shape was normal. The ultrasound performed in the emergency room had shown a healthy, albeit very small, baby.

"Bleeding, bleeding... where is it coming from? The patient is pregnant... Increase suction! Check her right fallopian tube!" Liu Banxia muttered to himself for a moment, then suddenly shouted.

Everyone was puzzled. They knew Liu Banxia suspected an ectopic pregnancy. However, the patient was already this far along in her pregnancy and would have definitely undergone comprehensive prenatal check-ups. How could it be possible?

Just as some blood was suctioned away, revealing the right fallopian tube, Liu Banxia immediately applied a hemostat. The clamp was placed at the uterine end of the tube.

"Her blood pressure is starting to rise!" Wang Lei exclaimed, watching the patient’s vital signs, a hint of excitement in his voice.

By now, the fallopian tube was clearly visible. At the ampullary region, it was bluish-purple and had already ruptured. That was the source of the bleeding.

Liu Banxia took out two more hemostats, clamping the mesosalpinx near the fimbrial end and then the isthmus of the fallopian tube. Only then did he truly relax.

"Oh my God, that scared me to death! Quickly, wipe my sweat. The rest is easy. Right salpingectomy. Liu Yiqing, go inform the family," Liu Banxia said, his tone a bit lighter.

"Teacher Liu, how is that possible? Isn’t the patient already 11 weeks pregnant? Hasn’t she had prenatal check-ups?" Xu Yino asked.

"It’s hard to say. It also depends on whether this was specifically looked for during the prenatal examinations," Liu Banxia replied.

"Let’s review the procedure. This is my first time performing a salpingectomy. It’s too late to call another doctor. What are the steps?"

"Um... uh... it’s just a routine procedure, right? Is there anything else we need to be careful about?" Xu Yino asked, lacking confidence.

"Haha, that’s right. Wait for Liu Yiqing to return. You’ll be the primary surgeon, and she’ll be your first assistant," Liu Banxia said with a laugh.

Xu Yino shot him a somewhat reproachful glance; she had thought it was going to be a very difficult surgery. In reality, Liu Banxia was just in a good mood after the successful resuscitation and decided to tease them a bit.

If it hadn’t ruptured, a salpingostomy could have been performed. But it was too late now. Being this far along, and with such a large rupture, removing the fallopian tube was the only option.

After a while, Liu Yiqing came in from outside and nodded.

"Don’t ectopic pregnancies in the ampulla and isthmus usually become symptomatic around week six or seven? This patient’s case is quite unusual," Wang Lei commented.

Liu Banxia nodded. "Interstitial ectopic pregnancies tend to rupture later because the interstitial portion is thicker, right?"

"Exactly! That’s why I didn’t think it was an ectopic pregnancy at first," Wang Lei said.

"I was out of options. I hadn’t considered this at first, then I just thought, ’What if?’ And it really turned out to be that ’what if’ scenario," Liu Banxia remarked.

"I really don’t know how their prenatal check-ups were done. This seems like a major oversight, doesn’t it? Normally, isn’t ectopic pregnancy screening standard?"

"Perhaps they overlooked the possibility of an ectopic pregnancy once they confirmed an intrauterine fetus. I’m not too familiar with this, so I’m just guessing."

"Let’s not dwell on it. Let the patient’s family figure it out. It might have just been negligence on the part of another doctor," Wang Lei said.

It could have been an oversight during the initial exam, or there could be other reasons. Regardless, this was the situation now, and it wasn’t Liu Banxia’s place to investigate further.

「DING! Emergency surgery completed.」

You have gained 200 experience points, 100 diagnostic skill proficiency, 50 dressing change skill proficiency, 50 suturing skill proficiency, and 5 Glory Points.

Liu Banxia was quite satisfied with these rewards, as this surgery hadn’t been very demanding. Furthermore, the system rewards had become somewhat thoughtful, compensating with Glory Points when it couldn’t give much for skill proficiency.

"Doctor, how did it go?" As soon as Liu Banxia stepped out, the patient’s husband rushed up to him.

"The surgery was successful, and the patient’s vital signs are stable right now. Her left fallopian tube is intact. It will affect ovulation to some extent, but if you want to have a second child in the future, it won’t have a major impact," Liu Banxia said.

"Because she was under general anesthesia, there will be a recovery period. Once she’s back in the ward, we’ll instruct you on her care. Since it was an emergency, we performed an open abdominal surgery."

The patient’s husband nodded and then looked at his wife, who was lying on the gurney.

"What exactly happened?" Wei Yuan asked curiously after they returned to the main hall.

"A ruptured ampullary ectopic pregnancy. It was quite a close call," Liu Banxia said.

"An ampullary ectopic pregnancy can rupture this late?" Wei Yuan asked in surprise.

"That’s the thing. Sigh, otherwise, it would have been twins. It’s a pity," Liu Banxia lamented.

Pregnant patients evoke such strong emotions because they carry a new life within them. An ectopic pregnancy must be terminated; otherwise, it poses a risk to the woman’s life.

But this one wasn’t in the right place. If it had been, it would have been a viable little life.

"Stop overthinking. You really need to broaden your skills now. You should be performing proper cardiac and neurosurgeries in the future," Wei Yuan teased.

"Brother Wei, if you had said this a few months ago, I might have had the confidence. But not anymore. The more I learn and see, the more I realize how little I know," Liu Banxia said.

"Like that awake surgery yesterday, and those craniotomies in neurosurgery. Those require real skill. I can only muddle through at best; the postoperative results definitely wouldn’t be as good as theirs."

"For emergency procedures, I can barely manage. But for serious, complex operations, without putting in significant effort, I really can’t handle them. I was too naive before, thinking things were simpler than they are."

"Well, not bad. That’s real growth. But are you really going to keep tormenting Wang Chao like this? He’s been looking miserable all day," Wei Yuan said.

"This was his choice. The task seems simple, but it’s actually quite complex. Every step must be precise, or it just won’t work out," Liu Banxia said.

"Right now, I’m just hoping the obstetricians arrive soon, and doctors from other departments too. Apart from orthopedics and internal medicine, where I still have some confidence, I’m really not up to par with other specialties."

"We always used to say, ’Live and learn.’ I’ve truly experienced that recently. Every department has its own specialized skills. I haven’t even fully mastered the skills of my own department, so I shouldn’t be thinking about others yet."

"Chen Xuehai’s mini-thoracotomy yesterday was indeed very well done. Anyway, just keep up the hard work. You don’t necessarily have to innovate. If you can just increase your speed in routine surgeries, that’ll be great," Wei Yuan said.

"But why are you only scheduled for two minimally invasive appendectomies tomorrow? Not helping clear the surgical backlog anymore? You don’t have to give all of them to us."

Liu Banxia shook his head. "It’s not about giving them away. As long as I can get into the OR once a week to maintain my skills, that’s enough. Patient numbers are increasing, and so is the workload."

"Besides, Sister Li is officially starting her new position soon. It’ll definitely be a bit chaotic at first, so I need to help keep an eye on things. The sacrifice she and her husband have made is significant; I need to help support her during this transition."

"Don’t worry. We’re all familiar with each other; no one will just stand by and gawk," Wei Yuan said.

This was indeed something to consider. An acting head nurse and a permanent head nurse were two completely different roles, and both would face a certain amount of pressure; the job wasn’t easy. 𝑓𝑟ℯ𝘦𝓌𝘦𝘣𝑛𝑜𝓋𝑒𝓁.𝑐ℴ𝓂

After a bit of chit-chat, Liu Banxia saw the patient’s husband approaching.

"Hello, do you have any questions?" Liu Banxia asked.

"Dr. Liu, our prenatal care was done at the county hospital. Is it possible they didn’t detect it?" the patient’s husband asked.

"I can’t give you a definitive answer on that, as I’m not an obstetrician-gynecologist, but it’s a possibility," Liu Banxia said after a moment’s thought.

The patient’s husband looked at him and nodded.

Liu Banxia, however, shook his head with a sigh, wondering if that other doctor would face a lawsuit over this.