I’ve had one case of hemorrhage, after surgery, three or five times into the operating room and almost had an accident.
The process is dangerous, and even our director is afraid to look back.
Patient’s name is Wu, male, 21 years old, fourth-grader.
He had the courage to go to the hospital during the summer break when I was in anal surgery and found us.
Hemorrhoids.
The patient told me that from four years ago when he went to college, he began to feel sick in his ass because he was sitting around playing games or something, often constipated, sometimes bleeding in the shit, sometimes with a small amount of blood, sometimes with anal damp, itching and pain.
At first he looked for information about smoke, anal baths, lubricated oils and so on.
Later, he also bought drugs, which were coated, and which initially appeared to have had some effect, but which was incomplete, which was still intermittent, bleeding, pain, damp and suffering.
He saw a doctor six months ago, not at our hospital, when the doctor said he had a hem, he had a hem, he had a hem, and he seemed to be very serious and had to consider surgery.
He didn’t say yes, but he was shy and worried about spending money.
I thought it was just a little hemorrhoid. I didn’t know hemorrhoids were going to be operated on, so I went on to take some medication and didn’t agree to the operation.
But obviously not this time.
“The last few days saw a lot of haemorrhaging, and the toilet was red several times. And the moistness, the pain, the alien feeling is very clear, and it feels like the whole ass is not mine, well, it would be better if it wasn’t. It’s useless. “The patient told me the truth.
So he came to our hospital for an anal surgery, and he was ready to do a big job to solve this shameful problem.
“Do your parents know?” I asked him.
After all, he’s a college student, no job.
The patient told me that he didn’t dare tell his parents to keep them from worrying.
And We poured cold water upon him, and said, “You, mixed hemorrhoids, are severe, so consider the surgical removal, but do not think that you can cut it off once and for all. If you do not take care of it, exercise more, raise your buttocks, prevent constipation, and find the hemorrhoids again.” Don’t think cutting is like throwing it away. I’m sorry.
He’s worried again, “Oh, my God, I thought it was done. I’m sorry.
I went on to explain to him that the so-called hemorrhoids, which are, in fact, the drop of some of the normal veins in the body’s anal, are normal human tissues, not bacterial infections and not foreign, so cutting off does not mean never again.
After intense ideological struggle, he decided to operate. After all, it’s awful.
If he could pull it out of his hand, he’d have pulled it all out of the trash can.
A letter of informed consent for the operation was signed. Pre-operative screening, including blood protocol, liver and kidney function, electrolytics, coagulation indicators, hepatitis B, syphilis, AIDS, etc.
Patient indicators are generally normal, except for blood routines of mild anaemia, haemoglobin 108g/L. Needless to say, hemorrhoids are a constant problem.
When everything was ready, on the third morning, the superior doctor took me to perform a corset.
By definition, the basic process of the operation is to strip out the hemorrhoid vascular complexes and ligate them and cut off the hemorrhoid cores.
In general, after the operation, the patient will be much more comfortable, because without this hemorrhoid nuclei, which is a few centimetres large, it will not be repeated.
The surgery went well.
But for the first two days after the operation, the patient was in pain, and I told him in advance.
Especially after anaesthesia, there’s still a clear pain in the ass and no tears.
But after these days, the future will be comfortable and he will no longer complain.
The third day after the surgery, things didn’t go so well.
The day the patient went to the toilet, not too hard, softly, but always drew red blood.
Looks at the red blood running out and the patient panics.
He took up his pants and went to a nurse who said there was a lot of blood and red red when he took a shit.
As soon as the nurse listened, she was alert.
He recalled that there was no way to estimate, but there would probably be half a bottle of mineral water, around 200ml.
The nurse got scared and informed me that I was on duty and that hemorrhaging was normal after hemorrhaging, but if it was high, it would be abnormal.
Subconscious told me that there might be problems.
The patient was lying on the side of the bed, was well-dressed, had no apparent anemia and had a stable breath, and I was slightly relieved.
I asked him a few questions and turned the covers over and looked at his pants, which were clean as a whole and showed no clear signs of red blood.
The bleeding could have stopped.
But for the sake of safety, after reporting to the superior physician, we arranged for a intestinal examination to see where the haemorrhage was and how bad it was.
The intestines are done.
It is true that there is a small hemorrhage point in the trauma of hemorrhage surgery, which is sometimes a little blood.
It would have been a problem, but since they’re all intestinal, they can’t just look at the ass, the rectum, so the goggles continue to push the intestines and look deeper.
I didn’t expect to see a bigger problem.
Around the position of the bacillus, the intestinal lens found visible vascular malformations, like an vascular tumour, and an aneurysm with a haemorrhage point, which occasionally seep.
Beta colon is probably at this position (in red font):
What a shock! Fortunately, the mirror continued to move, or else the deformed vascular tumor was missing.
Hemorrhaging after surgery, apart from the bleeding of the wound, is considered to be a major problem.
Since the bleeding is not so big, we communicate with the inner mirror doctor and spray it directly under the intestinal lens, in part, around the bleeding point, in an attempt to stop it.
The little hemorrhage in the hemorrhage, we stitched him up. And even deeper, the vascular tumors can’t be sutured, they’re all vascular clusters, and they bleed wherever the needles go.
If hemorrhages were to occur, it could be an vascular tumor, because a pure coagulator may not work very well. I thought.
I didn’t expect that to be the case.
Upon return to the ward, the patient took two bloodstains. Plus, there’s almost 200ml.
The patient was panicking, and I felt the situation was serious, so he called home and told his parents about the situation.
On the same day, the parents rushed out of the country.
We talked to the patient’s parents and said that although the operation had been completed, the patient had repeated haemorrhages, and it was probably the vascular tumor that had to be re-activated and cut off the intestinal part of the intestinal tumor in order to stop the bleeding.
“Can’t we just cut off the vascular tumor?” Do we have to cut the intestines off? “The parents of the patients are very worried and feel much white in the day.”
And I explained to them, “The aneurysm is all vascular, it’s hard to stop the bleeding, it’s better to cut the intestines together, it’s easier to sew the bleeding, it’s much better. I’m sorry.
Eventually, they agreed to the operation.
The next morning the patient was pushed into the operating room.
This is a caesarean section.
According to the intestinal lenses, the vascular tumor was inside the abdomen, so as soon as we entered the abdominal cavity, we started to examine the abdominal, and there was a swollen swollen in the abdominal.
In order to make sure that it’s not in the wrong place, the intestinal lens again confirms that, yes, the swelling that we found was the position of the vascular tumor that was seen under the colonoscopy.
Once we’re clear, we cut a part of the larvae, about 3 cm, and when we’re done, we reconnect the larvae and restore continuity.
The other intestines, the dirty organs, were then checked again and the abdomen were closed.
I’m sweating my back at this point. I don’t know how my superior doctor feels.
“We cut off the aneurysm, and we usually don’t bleed anymore. Once the intestinal tube fits, the food is fasted for a period of time, and later it will grow good and the problem will be small. I told my family after the surgery.
The family is also grateful to us. Who’s gonna have to call a doctor if something goes wrong with their children?
The blood is too precious for the child to bear.
Just when everyone thought there would be no more bleeding, reality hit their faces again.
That night of the operation, I was on duty again. I was in bad luck, and the patient was in bad luck.
The patient pulled hundreds of milligrams of blood again. I’ve been using my blood meds, and I’ve been taking blood to check the blood.
When you see red blood, you dye your pants and sheets red, and the parents of the patient suffer from pain and anxiety.
Patients themselves are worried, but they do so to comfort their parents.
I’m afraid I can’t handle the bleeding. There’s still a problem with the patient’s bleeding again.
There’s no reason for a few senior doctors to come back.
Whatever the problem, it seems to be a big one. This is our most distressing situation.
Once again, the director spoke to the parents of the patient and said that it would be a problem to go into the abdominal surgery for the second time and check out where the bleeding was.
The parents of the patients were already terrified. What we say is what we do when we can help the kids.
The patient was then pushed directly into the operating room in the early hours of the day for further caesarean examination.
“Something’s wrong where it fits.” The former chief told us.
It’s true that the operation went into a state of sight, and it really did match the mouth hemorrhage.
At the time of the first operation, they had cut off the intestinal tract where the vascular tumor was located and then tied the two ends together, and now it is found that there is a permeation of blood, which is believed to be poorly sewd.
The director was upset and probably blamed us for not stitching, but he swallowed it back in his mouth.
Because he sewd it all himself.
The director then told us that he couldn’t figure it out, that he had a good stitch and saw it clearly.
But the director is only 50 years old, and he’s in his prime.
The next time, it seems, it will have to be done with more care and attention, as well as with anti-infection, prevention of haemorrhage and end of bleeding.
It was determined that the haemorrhage was consistent with the mouth, which meant that the intestines could no longer be used because of the edema, which could only result in a more severe haemorrhaging if it continued.
We had to cut off the intestines of this miserable child and then stitch up the new two ends.
It will be called a retreat.
“As long as there is no more bleeding, a few centimeters less of the intestine is nothing. The director told us.
“If you keep bleeding, our sign will be ruined. They’ll say a little hemorrhoid surgery, so they can’t stop bleeding, and I won’t be able to see anyone. I’m sorry.
The director carefully checked the chest and confirmed that there was no further bleeding and that the stitches were beautiful, so that he was able to keep his stomach shut.
We’re all relieved.
What was unexpected was that two days later, one night, the patient was on the brink of death.
The day the patient had just walked down for a few minutes and suddenly felt the feeling of anal bloatedness, which scared him because it meant that he was bleeding again.
And soon again he showed signs of panic, paleness and coldness of his limbs.
That’s right. He’s got hundreds of milligrams of blood.
The family is crazy, and I’m scared.
This is clearly the rhythm of haemorrhagic shock, which means that the patient is bleeding very quickly and in very large quantities this time, otherwise the patient will not be in shock in two days, knowing that there will be blood transfusions, and that there will be haemorrhagic shock in such a situation, and how fierce the bleeding is.
There is no other way, and there can be no momentary hesitation.
The chief was faceless and said he had to deliver it to the operating room and stop the bleeding again. The family’s lips were shaking and there was no alternative to signing.
The patient was given a blood transfusion and sent to the operating room.
Before entering the operating room, the blood pressure of the patient was as low as 90/60 mm/Hg, and I myself was a little freaked out, but I had to tell myself to calm down.
This is the haemorrhagic shock caused by the haemorrhage.
Check for blood protein, only 65g/L.
Crazy!
The chief lays his hand down, opens his tummy and first examines the intestinal line. But the match was clean and there was no sign of bleeding.
The director then asked the endoscope doctor to bring the equipment, and at the same time to do the intestinal lenses, to see which intestinal hemorrhage it was.
The colonoscopy showed a haemorrhage at 2 cm above the wound of the first hemorrhagic operation, because the blood was in the intestine, not in the mouth, so the caesarean section was invisible.
The director calmly stung the blood spot and then stuffed some of the oil veils (with a liner) into the pressure to stop the bleeding.
I expect no more bleeding this time. In fact, the patient’s shock was also corrected.
The oil veil can crush the wound around it and act as a stopgap. But oppression alone is not enough. It has to lead.
Why?
If there’s blood on top of it, you can’t stop it, so you can’t see it. You don’t think there’s blood.
So there must be a lead pipe in the middle of the tarp, which opens right above it.
So that if there’s any bleeding, the blood can be drained from the catheter.
So we can see if there’s still blood in it.
I wish the pipe was clean and clean.
Everyone wants to.
The parents of the patients have also turned on the truncheons more than 10 times in an hour, and they are so nervous if they have a bit of wind.
The kid’s too hard. He’s had a one-off surgery. He’s done it four to five times. The whole man lost a few laps of weight and his face was waxed.
There’s no pain in being a parent.
But things are far from over.
A few hours after the surgery, I observed that there was a flow of blood that began to flow, but it did not seem to stop.
Hemorrhage was judged.
However, because of the negative and repeated local stoppage, it was not effective to contact the intervention section. Let’s see if we can stop the bleeding.
Interventions generally work well.
In short, the interventionian puts a catheter in the patient’s vein and then inserts it into the picturing agent. If there’s a leak in one of the vessels, then the agent leaks there, and the doctor shoots X, so he can see the seething, and he can infer which of the veins is bleeding.
It’s easy to find a blood-stained vein, also known as an artery.
The doctor then pushes some of the clinkers to the front of the blood vessels and releases them, and they block the veins, and there is no blood flow, and there will be no bleeding.
It’s called precision, finding the killer, then starving or killing.
I thought it would stop the bleeding.
That is what everyone thinks, because intervention in the bleeding is good and the last straw.
But that’s what fate is.
The day after the intervention, 200ml of the patient’s blood was again administered.
We’re going to cry.
“What’s wrong, the patient’s coagulation indicators have been checked several times and there are no coagulation disorders. “We all know that the director is mad, he’s not someone else, he’s not a patient, he’s angry with himself. The set of indicators of condensation that patients have examined is largely normal and individual indicators are higher, but the consideration of haemorrhage is not particularly significant.
Head’s bigger.
“It is important to refine all the indicators of condensed blood to see if hemorrhage is a result of coagulation disorder. The director is about to shoot the table.
“Is there a haemophilia? I am weak in making a point.
I’ve been thinking about this a few times, but after all, hemophilia isn’t very common, how come we’re so unhappy that we haven’t found him?
Several directors did not speak, and no one could deny my claim, but neither could anyone agree with it.
They have not seen haemophilia, patients with haemophilia can easily bleed, and patients can easily bleed when they have twitched and touched.
That’s what I thought.
“But it is not excluded that the patient has a very mild haemophilia.” “The director suddenly said something cold.
“Did you check the whole set of coagulation factors? He asked me.
In general, when a surgical patient enquires about coagulation, only a few commonly used indicators, such as the original time of condensation, the time of active partial coagulation, are a combination of coagulation factors, which generally means that coagulation is largely normal.
No one will look directly at each specific condensation value, which is more problematic and of little significance.
But the patient’s repeated haemorrhage is of great significance.
“Let’s check on haemophilia. The director said without an expression, “Let’s check the data and see if there’s any other problems with coagulation. Also, get blood in here and help with the consultations, see if you can find anything. I’m sorry.
In order to get a blood-surgery consultation, there is a real hope that someone will give instructions, after all, that the art profession is specialized. The other is, of course, to share responsibilities.
If something happens to the patient, they find out that you can’t help yourself with this problem.
After the arrival of the blood physician, a careful assessment of the condition was made, and there was some interest in the question we raised about haemophilia.
However, they asked repeatedly that patients had no history of haemorrhaging, which was not like haemophilia.
“A typical haemophiliac disease is more likely to bleed, and a bump can be bruised and even a toothbleed cannot stop. Hemopathologists say they are impressed by the occasional haemophiliac patients.
However, in order to rule out the diagnosis, hemophilia testing should be improved.
Under the guidance of a blood physician, I took blood from the patient for a relevant coagulation test. I’m also working with my family to improve genetic testing.
Because hemophilia is a genetic disease, if genetic tests can detect anomalies, it’s a hammer.
The examination must be accompanied by constant blood transfusions, rehydrations and blood stoppages. Fortunately, the patient has not continued to bleed for the last two days or has no idea what to do.
This day, the coagulator came back.
We saw it, we were shocked, and we called a blood doctor.
“God! The patient is really hemophilia! “The blood doctor is crying out.
It’s a haemophilia.
Turning around, the patient was really suffering from congenital condensation disorders.
More dramaticly, the usual indicators of condensation are not capable of assessing hemophilia, and to determine if hemophilia is available, hemophilia can only be tested for condensation or genetics, but they are not generally performed before the surgery, which is not common.
You’re blind. The chief’s angry. The weird one is himself.
Perhaps he was thinking that a reminder from Dr. Frédéré might have solved the problem.
I’m a blind cat too. I’m lucky to be dead. I’ve never seen hemophilia before, just in my books.
Anyway, a diagnosis is good.
Hemophilia is a lack of some of the coagulation factors arising from congenital genes, which are classified as hemophilia A, hemophilia B and hemophilia C according to the type of factors lacking.
This patient, the missing coagulator is FVIII. So hemophilia type A.
The usual fresh, frozen blood plasma, cold sediment, etc. contain a number of condensers that can be used to treat haemophilia, but because of the stress of blood, the patients use not fresh but ordinary blood plasma each time, so there are not enough additional condensers, and the patient has haemophilia, which is the reason why hemorrhage is repeated.
Parents can’t believe that their children have haemophilia. “We’re both good people. How can we have children? I’m sorry.
So, I did my homework in advance, and I explained to them, “This haemophilia disease is genetic and doesn’t mean that all children have it. Your son has haemophilia, and we assume that the mother is hidden and the father is normal. You can finish this later. I’m sorry.
That makes the parents of the patients even more confused.
But in any case, finding the problem is better than anything.
Then we treated the patient with a specific condenser and added some fresh plasma, cold sediment, etc., and with other treatment, the patient finally stopped bleeding.
After this time, the director had less hair. It’s a good thing they don’t bother. He paid for his medicine.
I also have a question as to why patients who are hemophiliacs do not normally experience bleeding.
According to the blood doctor: “In terms of indicators, the patient is a relatively minor hemophilia, and it is possible that only cases such as surgical trauma can lead to more than haemorrhage and that daily bumps do not cause harm. I’m sorry.
I see.
The patient really survived this time.
The director said, “We must also warn ourselves, and we are among the dead.” I’m sorry.
Cope class.
Do hemorrhoids have to be operated on?
No, it is generally conservative treatments, whether internal or external, such as eating vegetables and fruits, keeping the poop free, using permutants, hot water for a bath, potassium permanganate for a bath, hemorrhoid ointments, etc. The more serious internal cavities can be considered for coagulation or inoculation.
It’s not that big a wound. It’s good.
Only severe hemorrhoids require surgery.
It is important to know, however, that the operation cannot be broken, that it may also have complications, and that hemorrhoids can never be cut again if they do not change bad living habits (e.g. no fruit and vegetables, easy constipation, etc.).
What is hemophilia?
Hemophilia is a disease that causes haemorrhage as a result of genetic condensation disorders, which can easily result in spontaneous haemorrhage, but it is also related to the severity of the condition. Heavy patients can easily haemorrhage, such as muscle or joint haemorrhage, light patients (the patient in this paper) are not easily self-inflicted, and there is no apparent haemorrhage in normal life, but severe haemorrhage can result from surgery or severe trauma.
Hemophilia is relatively rare and both diagnosis and treatment are complex and require a comprehensive approach.
If a person’s life is prone to haemorrhage, he or she must visit a hospital in time to improve the examination. Record number: YX11Dn7yvVY
I don’t know.
Keep your eyes on the road.
