Chapter 273 - 181: Play My BGM

Chapter 273: Chapter 181: Play My BGM

The atmosphere in the operating room was tense and frigid. No one dared to speak.

Everyone was waiting for the lead surgeon to take his position.

Notably,

Liu Jianbang, director of the Department of Critical Care Medicine, and Zhao Yumin, a senior attending physician from the Emergency Department, were standing in the positions of first and second assistants.

This arrangement was utterly absurd.

’Jiang He, a new doctor, as lead surgeon? With a department director as his assistant?’

This level of prestige was almost on par with Yang Xu’s.

"Dr. Jiang, your surgical gown." The circulating nurse, Chen Jing, quickly came forward, shaking out the sterile gown.

Jiang He slipped his hands into the sleeves, and Chen Jing skillfully went around his back to tie the straps.

The scrub nurse handed him sterile gloves. Jiang He snapped them on, the rubber clinging tightly to his skin.

Jiang He: "Vitals."

Old Li: "Intubation is complete, ventilating with pure oxygen, but her systolic pressure is barely holding at 85. Heart rate is 145. We just checked her intra-abdominal pressure; it’s approaching 28 mmHg. Airway resistance is very high, the diaphragm is completely pushed up, and her lungs can’t expand. Dr. Jiang, you have to be fast. She can’t hold on for much longer."

"Understood." Jiang He looked down at the operating table.

Zhang Jiaqi’s abdomen was severely distended, the skin shiny from the internal pressure.

"Drape."

Liu Jianbang and Zhao Yumin immediately complied, swiftly laying down the sterile fenestrated drape.

"Number 22 blade."

The Lancet was slapped into his palm.

Jiang He pressed the tip of the blade just below the xiphoid process and, following the linea alba, made a decisive incision down to three finger-widths below the umbilicus.

A standard midline incision.

The blade sliced through the skin and subcutaneous tissue.

The fat layer appeared pale and fragile from the extreme edema.

"Bovie, coag."

Jiang He took forceps in his left hand and the monopolar Bovie in his right. White smoke rose with a SIZZLING sound.

Without a moment’s pause, he sliced straight through the linea alba.

PSHHHH—!

The immense intra-abdominal pressure had found an outlet.

Dark red exudate sprayed out like a fountain, splashing all over Jiang He.

"Suction." Jiang He’s voice was completely flat.

Zhao Yumin immediately inserted the wide-bore suction tube into the incision.

SLURP—

The suction canister was instantly more than half-full of a turbid fluid.

Floating in the liquid were numerous saponification plaques—the product of fat being digested and broken down by pancreatic enzymes.

The entire operating room was immediately filled with a nauseating stench.

"The amount of exudate..." Liu Jianbang sucked in a sharp breath. "That’s at least fifteen hundred milliliters. It’s all toxins."

"The abdomen is decompressed. Watch for reperfusion injury causing a sudden drop in blood pressure. Old Li, keep up with the volume expansion, speed up the norepinephrine."

Jiang He reached both hands into the abdominal cavity. "Director Liu, large S-retractor, go in on the right, pull towards the two o’clock position. Dr. Zhao, left side, ten o’clock position. Pull hard."

Liu Jianbang and Zhao Yumin immediately hooked the retractors as instructed and pulled them apart.

The abdominal cavity was completely exposed under the shadowless lamp.

The sight before them made the scalps of the two battle-hardened senior doctors tingle.

The intestines were swollen, their surfaces covered with ecchymosis and necrotic spots. They were adhered to each other, having completely lost their normal anatomical structure.

The stomach was pushed high up, and the greater omentum was densely packed with saponification nodules.

"How are we supposed to find the pancreas in this?" Zhao Yumin’s hands felt a little stiff.

Everything was adhered together; the anatomy was a complete mess.

One wrong cut, a nicked intestine or blood vessel, and it would be impossible to suture in its current inflamed state.

"Wet gauze, to pack off the bowel," Jiang He said, holding out his hand.

The scrub nurse handed him gauze soaked in warm saline.

Using his hand to guide the gauze, Jiang He pushed the swollen transverse colon downward and retracted the stomach upward.

"Cautery."

Jiang He took the Bovie and went straight for the gastrocolic ligament.

This was the only way to enter the lesser sac and expose the pancreas.

Normally, the tissue here was loose and easy to separate, but now, it was completely soaked and rotten from the inflammatory exudate.

With the forceps in his left hand, Jiang He lifted the tissue, while the Bovie in his right made precise, targeted touches.

Not a shred of hesitation.

Watching from the other side, the corner of Liu Jianbang’s eye twitched.

Jiang He’s Bovie was practically scraping along the edge of the middle colic artery and vein.

In a surgical field filled with edematous fluid, he even suspected Jiang He was cutting with his eyes closed.

’This kid... is he navigating purely on muscle memory?’

’How many fucking surgeries did you even perform in medical school?’

"It’s open."

In less than a minute, the gastrocolic ligament was completely divided.

The pancreas, hidden behind the peritoneum, was exposed.

But the entire room fell silent once more.

A normal pancreas is soft and pale yellow.

But this one was swollen to at least three times its normal size, transformed into a mass of purplish-black, rotting flesh.

The surrounding anterior renal fascia (Gerota’s fascia) had been completely dissolved by the inflammatory exudate.

"It’s... all necrotic." Liu Jianbang’s voice was tight.

"The core region still has blood flow. Beginning debridement." Jiang He put down the Bovie. "Oval forceps, long non-toothed forceps."

The greatest difficulty in an open surgery for SAP is knowing how far to go.

The necrotic tissue must be removed, or it will continue to release toxins. But if the debridement is too deep, nicking the splenic artery and vein or the gastroduodenal artery hidden around the pancreas, the patient will instantly go into hemorrhagic shock and die on the table.

Jiang He’s right index finger traced the edge of the pancreatic capsule, gently probing into the rotten sludge as the pad of his finger felt for the tissue’s tension.

"Dr. Zhao, follow my finger with the suction. Only aspirate the dissected tissue. Don’t touch the vessels."

Jiang He began the blunt dissection.

He scooped out the black, necrotic tissue bit by bit; it was as crumbly as tofu dregs.

His fingers were like they had eyes of their own, precisely avoiding every landmine in the bloody, indistinct pit.

Zhao Yumin started to sweat.

He realized he was actually struggling to keep up with Jiang He’s pace!

Half a second too slow, and the field would be flooded with blood; half a second too fast, and the suction would latch onto an organ.