bookpower Chapter 726
Chapter 726
Xiao Ru on the side said: "Don't worry, the effect of general antibiotics depends on 3 days, and the effect is not so fast." "
Hear this.
Although the patient's parents were still nervous, they resisted the idea of continuing to question.
However.
Unexpectedly, after 3 days.
The patient still has a fever.
Blood tests show that the white blood cell count is still very high.
This is clearly not right.
When Xiao was so young, he could not resist the patient's parents' questions.
Lin Feng also had some headaches.
No matter how you look at it, it is ordinary inflammation.
But antibiotics just don't work at all.
And now it can only be treated with drugs, the patient's neck is so obviously red, swollen and hot, which means that it is the acute stage of inflammation, and the knife cannot be used, otherwise there is no way to heal if it is cut!
The patient now has repeated redness, swelling, heat and pain in the neck, there must be some hidden disease!
The first task now is to find out the hidden diseases of the patient.
Otherwise, there is no way to cure it, even if it is temporarily resolved, it will definitely recur later.
Lin Feng's brain was running quickly, thinking about the possible cause of the patient's current symptoms.
"Teacher, could the patient be the cause of the thyroid gland?" Xiao Ru said softly when she saw that Lin Feng was silent and was pondering.
Suddenly.
A light flashed in Lin Feng's mind.
Not the thyroid gland!
Where is that?
The thyroid gland is close to the throat!
Piriformis fistula!
The disease immediately came to mind!
It's rare to encounter this condition in an emergency department!
When it comes to piriform fistulas, then it is necessary to talk about the piriform fossa.
It is near the delay of the human body, there is a small crypt, shaped like the concave head of the fruit pear, but also like dimples, so it is called a pear-like fossa, one on the left and right.
If the congenital embryo does not develop well, the tube that should have been closed is not closed, resulting in the formation of a fistula, then the food or bacteria in the throat will spread through the fistula all the way to the skin of the neck, and local bacteria are easy to multiply, causing infection, so the neck will be repeatedly red, swollen and hot.
Because he had been paying attention to the thyroid gland and the lump of the patient's neck, Lin Feng did not expect this disease.
Today's Xiaoru words are like alarm bells in his mind.
And generally not otolaryngologists, basically do not recognize this condition.
The vast majority of the disease begins in children, and a few are recurrent in young people.
Moreover, more than 90% of the onset site is the left side of the neck, not the right side of the neck, and the patient is exactly on the left side, so it is very consistent with the characteristics of piriform fistula.
And the internal fistula formed by piriformis fistula often causes recurrent purulent infection of the neck and may also involve the surrounding thyroid tissue, but it is still different from subacute thyroiditis.
After listening to Lin Feng's words.
The patient's parents hurriedly asked: "Dr. Lin, these are your speculations! So how to check to confirm whether it is what you said, piriform fossa fistula?"
Lin Feng smiled slightly, and said softly: "This is very simple, just do an angiography! Do hypopharyngeal angiography, as long as you can see a complete fistula, then the diagnosis is undoubtedly confirmed!
The patient's parents immediately smiled and said eagerly: "Dr. Lin, then hurry up and do this imaging for my son!"
Hearing this, Lin Feng shook his head.
Under the doubtful gazes of the patient's parents, he slowly said: "Not now! Your son's inflammation is so obvious now, the neck is red, swollen, hot and painful, it is estimated that the fistula has also been filled with inflammatory tissue, the tube may not be visible at all, and it needs to be checked after the inflammation disappears!"
Looking at his uncomfortable appearance, our hearts are even more uncomfortable!" the patient's mother said immediately.
Lin Feng thought for a while, and said softly: "My suggestion is to continue antibiotic treatment first, and at the same time do a subcutaneous incision, I see that there are already abscesses here, if you don't cut it and discharge, I'm afraid it will be difficult to dissipate the inflammation, and at the same time do another puncture test to see if there are any special findings and ensure that there are other situations!"
The patient's parents hurriedly nodded in agreement, and urged Lin Feng to arrange it early, they naturally hoped that their son could get better as soon as possible.
Lin Feng nodded.
First arrange for puncture and aspiration under the guidance of B ultrasound, and 20ml of pus is extracted and sent to the laboratory.
Then begin to prepare the neck abscess incision.
In order to reassure the patient's parents and patients, this time it was Lin Feng who personally handled it.
The minor surgery went well.
The patient was given antibiotics while the abscess was cut and drained, and the local infection was quickly controlled.
Just like treating a stinking gutter, you need to dredge it with an excavator (cut the abscess and drain it) while waterproof it to wash away dirt (with antibiotics).
Finally!
Living up to expectations, the patient's condition gradually improved.
The swelling and pain of the neck are significantly reduced, the sore throat is gone, and the fever is gone.
After re-examination, infection indicators also decreased.
The situation stabilized.
Next, you can do pharyngeal angiography.
Under the eager gaze of the patient's parents, Lin Feng pushed the patient into the imaging department.
After starting.
Lin Feng stared intently, waiting for the screen.
But the result surprised him.
No!
Nothing!
Fistulas were not found at all.
"Teacher?" said Xiao Ru as she leaned in.
It should be that the inflammation has not completely dissipated, and there should still be something blocked inside the fistula, so the imaging cannot be seen." Let's do an electronic laryngoscope first, and see if we can find the internal fistula of the piriform fossa under direct vision. Lin Feng said softly.
As soon as I walked out of the imaging department, the patient's parents greeted him.
Looking at Lin Feng expectantly, he asked in his mouth, "Doctor, how is it?"
Immediately, Lin Feng told them about the situation.
In the afternoon of the same day, an electronic laryngoscope was arranged, and Lin Feng personally operated it.
The mirror enters through the patient's nose, close to the throat, and the piriform fossa is nearby.
If there is a piriform fistula, a leak must be visible.
For example, there is a mountain in front of us, and if this mountain has a tunnel, we will definitely find the tunnel entrance.
Otherwise, it means that the mountain has no tunnels.
Of course, it is also possible that the weeds are overgrown and block the entrance to the tunnel.
Took a closer look.
No intra-piriformis fistulas were found.
However, the mucosa of the patient's left piriform fossa is somewhat swollen.
There should still be problems.
Maybe there are really weeds covering the entrance of the tunnel.
"Breathe, puff, continue to puff, hold your breath, hold your breath!!" Lin Feng immediately pinched the patient's nose and said in his mouth.
Really.
As soon as the patient puffs up, a fistula in the left piriform fossa comes out.
When holding your breath, the gas breaks through the internal fistula and is in full view.
.