While they were lamenting about it, the phone rang once more.
The landline of the emergency ward was different from the one in Old Chief Physician Pan’s office. The Chief would mostly receive calls about office politics between departments.
When the phone in the emergency ward rang, it was likely that the emergency department was either sending patients to them or that the patient had an ambiguous diagnosis that required Zheng Ren’s opinion.
After picking up the phone, Zheng Ren spoke for a while before getting up and heading downstairs.
“Boss, what’s the matter?” Su Yun asked.
“Intestinal obstruction in a fifteen-year-old girl,” Zheng Ren said.
“Let’s go check it out,” Su Yun followed Zheng Ren to the emergency department.
Intestinal obstruction could be caused by intussusception in the infant stage or from loss of function due to old age.
The patient was still a teenager; she should be in the pink of health. It was rare to see intestinal obstruction in a young girl like her.
When they arrived at the emergency department, the internal medicine doctors were busy tending to the never-ending crowd in the consultation room. Most of them were elderly patients above 60.
This was a common scene in the Northeastern region. The younger generation equipped with skills that had a future ahead all moved to the South in search of jobs, leaving the older folks behind.
When the doctor saw Zheng Ren, he quickly comforted the old man he was tending to and rushed over to Zheng Ren. He brought Zheng Ren to the emergency treatment room. On their way there, he said, “The patient is a fifteen-year-old girl. She has abdominal pain and was vomiting for two days before she visited the hospital. When I examined her, her abdomen was bloated, tender upon touching–general pain without any rebound tenderness. The CT scan on the abdomen showed an enlarged intestinal loop and extensive fecalith in the right abdominal cavity.”
The doctor’s voice was raspy from the non-stop talking from the morning till now. She was so busy that she had not had the time to have even a sip of water.
“What has been done?” Zheng Ren asked.
“We performed a hypertonic saline enema, but it was not effective,” the emergency internal medicine doctor answered. “After the enema, we imaged the plain films of the abdomen and saw that there was an increase in the extent and amount of small bowel distension, along with the presence of air-fluid levels.”
“Hmm,” Zheng Ren pondered.
When they reached the treatment room, he saw a girl curled up on the bed, continuously retching.
There was an anxious middle-aged woman wiping away tears while she gently patted the girl’s back.
“Chief Zheng, these are the scans. Please take a look at them. I’ll return to my post now,” the doctor briefed Zheng Ren quickly and hurried back to the consultation room.
Zheng Ren came to the side of the patient and positioned her in a supine position with her legs bent upwards. Then, he rubbed his hands together to warm them before starting the physical examination.
The patient was very thin, with long black hair. She also had big round eyes with long lashes, but they were watery because of all the vomiting.
“What’s your name?” Zheng Ren habitually asked for the patient’s information as he performed the examination. He placed his hand on the patient’s left upper abdomen.
“I’m Wang Yutong,” the girl fluttered her eyes and answered.
“Are you in middle or high school?” Zheng Ren casually asked as he explored the patient’s abdomen.
There was no prominent tenderness on her upper abdomen, which was a typical sign of bloating. However, the patient felt the pain when he reached the left lower abdomen.
Zheng Ren checked carefully to locate the exact location.
The System’s monitor diagnosed the intestinal obstruction as Rapunzel Syndrome.
Zheng Ren was a little lost. However, he had to act calm and collected even if he had questions, especially in front of the patient. This was the basic etiquette for a medical doctor.
After the examination, Zheng Ren tapped the girl’s shoulders and asked her to cover her abdomen.
He then walked toward the radiographic film viewer and put up the abdominal CT scans and plain films.
It was a typical case of intestinal obstruction, just like the emergency internal medicine doctor said previously. The air-fluid levels and fecalith were all typical symptoms of this disease.
Zheng Ren made a low hum.
Su Yun noticed something was not right when he saw Zheng Ren’s expression. He came over and asked softly, “Anything unusual, Boss?”
“What do you know about Rapunzel Syndrome?” Zheng Ren asked.
It never crossed Su Yun’s mind that Zheng Ren was actually consulting him. He thought his boss was quizzing him. He quickly searched his mind for information on Rapunzel Syndrome.
A genius like him also had impeccable memory.
Similar to those who made a name in history, Su Yun was equipped with all the skills they had, including photographic memory.
He only took him several seconds to recall information about Rapunzel Syndrome.
“Rapunzel Syndrome, a clinical disease first described by Vaughan Jr. in 1986, manifested by the patient’s trichotillomania and trichophagia. The swallowed hair would form a gastrolith and enter the small intestines, causing abdominal pain, vomiting, nausea, malnutrition, hematemesis, diarrhea, and intestinal obstruction if the condition is serious,” Su Yun answered softly as if he was back in school, standing beside an old respected professor.
‘A test? Did he think he could get me with such a simple question?’ Su Yun felt proud.
“Hmm,” Zheng Ren nodded after hearing what Su Yun said.
The patient’s symptoms matched the description. The intestinal obstruction could be caused by a long-term compulsive eating of hair, which developed into a gastrolith and blocked the colon.
The best treatment method for a conclusively diagnosed intestinal obstruction was surgical resection.
Since the diagnosis was confirmed, the patient could be prepped for surgery.
“Can the patient’s family follow me please?” Zheng Ren called out.
The patient’s mother was in the middle of taking care of her, so the father followed Zheng Ren out of the treatment room.
“Have you noticed your daughter displaying any unusual behavior?” Zheng Ren asked.
The patient’s father looked confused. He tried very hard to recall, but he could not understand what Zheng Ren was asking for.
“It’s okay if you don’t know,” Zheng Ren said kindly. “Your daughter is showing symptoms of intestinal obstruction. After looking at the scans, it was caused by fecalith in the intestines. An enema didn’t work, so I plan to treat her with surgery.”
Zheng Ren did not directly reveal to the father that the patient had Rapunzel Syndrome, for fear that it would upset him.
Sometimes, the chronology of the briefing was very important.
The patient’s parents would feel relieved after they treated her intestinal obstruction. The best option was to explain the cause of this disease and future treatment plans after showing them the gastrolith.
The patient’s father had no opinions and agreed with whatever Zheng Ren said.
Zheng Ren then called Su Yun to admit the patient and prepare the preoperative assessment for surgery.
