My Medical Skills Give Me Experience Points Chapter 1373 545: Rectal Fistula, Relatives Who Cause Trouble at the Drop of a Hat

A sense of caution always lingered within him regarding Jiang Wei, maintaining a certain distance. It felt somewhat surreal, this connection.

Jiang Wei was exceptionally outstanding, and her complete devotion to Zhou Can, a mere resident doctor, seemed incongruous with her evident sharp intellect and experience. Anything out of the ordinary warranted vigilant observation, and Zhou Can couldn't help but remain on guard.

"The female patient is in her fifties, presenting with superficial varicose veins in both lower limbs, with the left leg being the most severely affected. Preoperative swelling was considerable, so I performed high ligation and stripping surgery. Post-operation, her vital signs are stable, and her left leg is currently bandaged for compression. If no unforeseen issues arise, a swift recovery is expected."

Hee Hansheng's surgical proficiency had always been commendable. When he declared matters to be settled, they generally were. What Jiang Wei recounted differed little from his own assessment.

Zhou Can couldn't help but wonder if his apprehension was excessive. Perhaps she was simply seeking some freelance opportunities to supplement her income.

The following day, Zhou Can arrived for his shift to find Jiang Wei, as was her custom, already present and dressed in her work attire.

Undeniably, the nurse's uniform accentuated her curvaceous figure, and her natural beauty was quite striking. Unlike typical beauties, her skin possessed a healthy olive hue, complementing an impeccably proportioned physique. Furthermore, she moved with a grace and agility surpassing most women.

She clearly engaged in regular physical training.

"Hi, good morning!"

She offered Zhou Can a smile.

Seeing Zhou Can, a genuine smile naturally bloomed on her face, imparting a sense of profound comfort, akin to a refreshing spring breeze.

"Have you been waiting long?"

Following yesterday's developments, Zhou Can felt considerably less guarded around her.

"I just arrived. Thank you for introducing me to such a skilled surgeon yesterday. I also managed to earn a little extra income." She proactively voiced her appreciation to Zhou Can.

This could be considered a form of acknowledgment for Zhou Can.

"No problem. I'll head to change my clothes first."

After exchanging pleasantries, Zhou Can entered the changing room, emerging shortly after donning his white coat. He then commenced his rounds alongside Jiang Wei.

As their rounds progressed, they arrived at the room of a patient who had undergone rectal cancer surgery. Zhou Can examined the gastrointestinal decompression device, inquiring, "How are you feeling with the gastrointestinal decompression? Are you managing alright?"

The patient, a mere forty-six years old, was relatively young. Diagnosed with rectal cancer, she had undergone nearly three days of preoperative preparation, with Zhou Can having performed the surgery the previous day.

For rectal cancer operations, meticulous preoperative preparation is paramount. For instance, dietary restrictions commence three days prior, limiting intake to liquids only. During bowel preparation, to ensure adequate patient nutrition, medical professionals even administer enteral nutrition.

Commonly, supplements like Bai Pusu or Ensure are utilized.

Additionally, patients are advised to consume water infused with 10g of senna leaves daily.

Should convenience be a factor, approximately 50ml of 25% magnesium sulfate can be taken orally each evening.

Some patients find the senna leaf water more palatable, akin to drinking tea, making them more amenable to its use.

"Quite good!"

The patient displayed remarkable resilience, a truly courageous individual.

"Continue to monitor closely. Maintain continuous gastrointestinal decompression for approximately forty-eight hours. Once bowel sounds resume and you pass gas, you can commence consuming liquid foods. Today, a nurse and a doctor will perform anal dilation, and we will require your cooperation then."

Following the surgery, anal dilation is typically necessary for about three to four days, contingent upon the patient's physical condition. Beyond the inherent embarrassment, the dilation process can be quite painful.

All these measures are implemented to facilitate normal postoperative bowel movements.

"Jiang Wei, please review her care plan, paying special attention to nutritional support. If any improvements are possible, feel free to implement adjustments."

For patients in such critical condition, Zhou Can typically entrusts Jiang Wei with reviewing medication, nutritional strategies, and other care facets.

"Everything else appears to be in order, but the dosage for plasma and albumin supplementation might require slight modification. I will also formulate a postoperative liquid diet plan for the patient." She offered her assessment and recommendation after her review.

"Certainly!"

Zhou Can concurred with her proposal.

In female patients undergoing this specific rectal cancer surgery, the development of a fistula between the rectum and the urinary tract is a significant risk. Should such a fistula form, fecal matter could potentially exit through the urinary opening, a complication often proving difficult to repair with less-than-ideal outcomes.

When a straightforward vaginal fistula repair proves unsuccessful, abdominal surgery is typically the next course of action.

Given the patient's compromised bowel condition, Dr. Zhou Can harbored significant concerns about the potential development of a rectourethral fistula. It was for this precise reason that he had enlisted Jiang Wei to refine the patient care strategy.

...

On the third day subsequent to the operation, the very complication Dr. Zhou Can had most dreaded materialized.

During his morning rounds, the patient's family voiced their distress concerning a potent, offensive odor originating from the patient's lower extremities. As he drew back the bedclothes, the unmistakable stench of feces permeated the air, casting a heavy pall over his spirits. A subsequent examination confirmed the dire reality: fecal matter had indeed breached the urinary meatus.

The inherent bacterial load within feces, when allowed to escape into the urinary tract, presents a significant risk for inciting diverse inflammatory conditions in females, potentially escalating to grave complications.

The severity of this patient's pelvic adhesions, coupled with her already weakened intestinal state, had created a perilous surgical landscape.

Even during the procedure itself, Dr. Zhou Can had been plagued by a disquieting premonition.

His foreboding proved accurate, as the patient ultimately developed a rectourethral fistula.

This particular complication arises exclusively in female patients, a consequence of their distinct anatomical configuration. In essence, the posterior wall of the rectum lies in dangerously close proximity to the urethra.

This risk was further amplified in the case of the current patient, who had undergone a hysterectomy to address a malignant uterine neoplasm.