Another patient sacrificed by the refinement of modern medical specialization

Monday morning meeting is a routine case discussion time, mainly discussing difficult and critical cases from the previous week. However, everyone was in a heavy mood during this discussion. This is because this was a life that could have been saved, a young life.

The patient is only 23 years old and is in the advanced stage of ovarian cancer. Last Friday, the gynecological oncology department performed a tumor reduction surgery on her. This means that she has no chance of being completely cured and can only rely on the limited means to maintain and prolong her life.

Regarding the discussion on anesthesia, we mainly discussed the perioperative concerns of such a patient with advanced cancer and extreme malnutrition. Although our anesthesiology department does not have the ability to cure her underlying disease, at least we should avoid accidents during the operation and at least complete the purpose of the operation itself.

When we opened the medical records, we noticed a key point: everyone seemed to have some impression of this patient's name. It was not because her name was special, but because she had just had a stomach cancer surgery two weeks ago! However, in the previous case, there was no mention of ovarian cancer. This seemed to tell everyone that the ovarian cancer was not found in the previous surgery!

Looking back, I have a better impression of this patient. This is because I performed painless gastroscopy anesthesia on her during the examination before the last operation. In my memory, this patient was still relatively healthy at that time, at least nothing could be seen on the outside. When I asked her what symptoms she had, she just said that she had a stomachache recently and no medicine worked.

When the gastroscope was inserted into the stomach, the real culprit surfaced - there was an obvious tumor on the stomach. We were used to seeing tumors, and we basically determined that it was not a good thing. Looking back at her young face, we were all sorry. When we asked her boyfriend about her situation, her boyfriend said that she had always paid attention to her body shape, ate less, and always ate some takeouts without nutrition.

At that moment, we all seemed to blame the takeaway for the problem. You know, the hygiene of takeaway food is really terrible. Not to mention health. As long as customers think it smells good, unscrupulous vendors will put anything in the food.

Afterwards, the general surgery department arranged for the patient to be hospitalized for surgery. There was nothing unusual during the operation, it was just an ordinary gastric cancer surgery. After the operation, he recovered normally as usual.

However, we never imagined that she actually had another cancer in her body - ovarian cancer.

The onset of the disease this time was not due to any new symptoms, but the pathological results of the previous surgery. The pathological results showed that her stomach tumor did not originate from the stomach itself, but was derived from her ovarian tumor that metastasized to the stomach.

【Knowledge point】: Ovarian cancer metastasizes to the stomach infrequently, but it is not impossible. In comparison, primary tumors in other tissues and organs of the human body are more likely to metastasize to the ovaries, such as breast, gastrointestinal, reproductive, and urinary system tumors, the most common of which are stomach and colon, such as Krukenberg tumors that originate in the gastrointestinal tract.

Although it is a rare clinical situation, it also triggers our deep thinking: in clinical work, there seem to be many similar cases! For example, a patient with heart disease is treated as a stomach disease by the gastroenterology department. This is caused simply because the patient has symptoms similar to stomach pain. In fact, it is angina pectoris caused by myocardial ischemia that happens to occur near the stomach.

【Knowledge point】: We all know that typical angina pectoris is a sudden squeezing, stuffy or suffocating pain located behind the upper or middle part of the sternum, which may also affect most of the precordial area, radiate to the left shoulder, the anterior medial side of the left upper limb, and reach the ring finger and little finger, occasionally accompanied by a sense of impending death. Atypical angina pectoris pain may be located in the lower part of the sternum, the left precordial area or the upper abdomen, radiate to the neck, mandible, left scapula or right anterior chest, and the pain may disappear quickly or only cause discomfort and stuffiness in the left anterior chest.

Back to this case, we are very clear that this is a serious misdiagnosis. Assuming that the general surgeon could have thought of the possibility of originating from the ovaries and conducted relevant examinations for ovarian cancer, would it be very likely that the culprit of ovarian cancer would have been discovered during the first operation? Taking a step back, even if it was not discovered before the operation, would there be a chance to discover it by carefully examining the various organs in the abdomen and pelvis during the operation? Because according to the results of the second operation, the tumor was already very large, and it would definitely have been discovered in the first operation.

From what we know about this surgical colleague, he is not a careless person. Most likely, he never thought that the tumor might come from the ovary.

Overall, the problem is that the division of departments is too detailed. In the past, the liver, gallbladder, pancreas, spleen, kidney, etc. were all classified as general surgery; now, every organ is divided into a department. Have you ever thought about whether the patient agrees with your division? The patient is a whole person!

However, nothing could be undone. This young life was almost frozen in a few months.

Seeing the increasingly sophisticated specialization of surgery, we are sometimes really worried. Although during surgery, our anesthesiology department can shoulder the responsibility of protecting the patient's life safety. However, this is not a matter of one discipline. Suppose a patient has acute massive bleeding, and your surgery department cannot stop the bleeding, how can our anesthesiology department save his life? We are really worried that one day, an emergency surgery that requires global coordination will encounter a surgeon who only sees the local situation.

Let me reiterate our opinion: we are not against the refinement of subject division, but we hope that while you develop your knowledge in depth, you will not neglect the horizontal development of knowledge.