15 Appendicitis That Still Hurts After Removal

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Luo Hao didn’t even ask what was going on; without brushing his teeth or washing his face, he dashed out of the house and caught the number 307 bus.

He drove to the hospital.

“Luo Hao, there’s a complaint in General Surgery. Take a look at the patient’s records.”

Upon entering Lin Yuming’s office, Lin wasted no time and got straight to the point.

“The patient was diagnosed with acute appendicitis and underwent an appendectomy, but has been experiencing persistent pain in the lower right abdomen since. Director Wen says the patient is just being fussy and has a low pain threshold. However, after half a month, the pain hasn’t improved. When the patient sought out Director Wen, he ignored them. Eventually, the patient’s family filed a complaint with the medical affairs office.”

Lin Yuming stood up as he handed the computer over to Luo Hao, succinctly summarizing the situation.

Pain after appendectomy?

Luo Hao’s first instinct was that there shouldn’t be any issues.

But a few days of pain was normal; half a month was a serious matter.

Before Lin Yuming finished speaking, a notification chimed in Luo Hao’s ear from the system.

[Urgent Task: Not a Simple Appendicitis.

Task: Identify the cause of post-appendectomy pain in the patient and cure it.

Deadline: 3 days.

Reward: 10,000 experience points, Acting skill level +1.]

“...” Luo Hao stared silently at the system’s reward.

He wasn’t interested in the entertainment industry, so acting skills were useless to him.

If only the skill level +1 applied to surgery—that would be wonderful.

If the gray surgical techniques in the system’s tech tree lit up, he’d have many more options.

Even if it didn’t boost surgical skills, receiving diagnostic AI fragments would be beneficial.

“Luo Hao, having difficulties?” Lin Yuming frowned coldly, noticing Luo’s brief daze.

“Huh?”

“Scared of that Wen Youren?” Lin sneered. “He tattled to the patient’s family, trying to sue for calling in an outside expert. I suppressed it at the time—did you think I was afraid?”

Luo Hao smiled brightly and shook his head.

“Uncle, I’m not scared.”

“Good. First, review the medical records and try to resolve this properly without leaving any hidden problems. If you can handle it smoothly, I’ll arrange for you to be stationed in General Surgery before the New Year. You think Director Wen wants a peaceful holiday? Dream on!”

Images of the fish-patterned scrubs and embroidered spring knives filled Luo Hao’s mind.

It seemed Uncle Lin intended to teach Director Wen a lesson, to stop him from scheming behind people’s backs.

With a bright smile, Luo Hao sat before the computer and began reviewing the records.

The patient: male, 42 years old. Presented at the ER with abdominal pain and diarrhea for three days. (Half a month ago)

Pain began around the navel and then shifted to the lower right abdomen, progressively worsening.

The pain was sharp; movement and eating aggravated it, while oral analgesics like paracetamol partially relieved it. Pain was associated with low-grade fever and decreased appetite.

Abdominal palpation revealed a soft abdomen with diffuse tenderness, most pronounced in the right iliac fossa with rebound tenderness. Colon inflation test was positive.

Initial labs showed elevated white blood cell count and inflammatory markers (including ESR and CRP). Liver and kidney function normal.

Preliminary diagnosis: acute appendicitis. That night, laparoscopic appendectomy under general anesthesia was performed.

Postoperatively, recovery was unsatisfactory, with persistent right lower abdominal pain.

The records described classic acute appendicitis, and the surgical notes followed the standard template. Luo Hao saw no obvious issues.

But clinical records often tell only part of the story; to confirm the diagnosis, a physical exam and direct interview were necessary.

Moreover, the diagnostic AI in the upper right system panel had not provided a definitive diagnosis due to insufficient data.

Luo Hao pondered.

After a few minutes, Lin Yuming asked, “Little Screw, any thoughts?”

“Uncle, the data’s insufficient. I have no conclusions yet. I’ll visit the ward to examine and interview directly, see if I can find a breakthrough,” Luo Hao replied.

Lin nodded.

He knew that just reading the records wouldn’t reveal the underlying issues.

Medical records are often copy-pasted from templates, making them nearly indistinguishable.

Reviewing the records mainly helps identify specific lab abnormalities or details. Diagnosing from these third-rate records alone was extremely difficult.

“Let’s go,” Lin Yuming beckoned Luo out of the administrative building towards General Surgery.

Dawn was breaking; nurses busied themselves with blood draws, and in the doctor’s office, a heavily masked doctor sat dazed.

Seeing the signature mask, Luo recognized him immediately as Chen Yong.

“Dr. Chen, you’re on duty?” Luo greeted.

“Uh...ah?” Chen was startled to see Luo, then noticed Lin Yuming behind him.

He stood up abruptly, nervously muttering, “Director Lin…”

“There’s a complaint. I’m here to see the patient after the appendectomy,” Lin said coolly.

Noticing both Lin and Luo wore white coats, Chen seemed to understand the situation.

“Are the patient’s family calm?” Lin asked.

“So-so. They just want to find what’s wrong and make the patient stop hurting,” Chen replied awkwardly.

Lin nodded and followed Chen to the ward.

It was still early; the patient's companion was asleep on the bedside couch, snoring softly. The patient lay on his side, face twisted in pain.

“Feeling better?” Chen asked.

The patient shook his head slightly.

“Uh…” Chen was about to introduce Director Lin but stopped when Lin shook his head slightly.

Behind his mask, Chen pursed his lips, trying to guess why Director Lin was personally involved.

“Please lie still, I’ll examine you,” Luo said with a warm smile.

A beam of morning sunlight streamed past Luo’s ear, casting a rosy glow that made his smile even more radiant.

As he spoke, Luo rubbed his hands together.

“It’s a bit chilly outside, but the room’s warm.”

The patient, seeing the two doctors—one older, one younger—didn’t seem surprised, only complaining, “Others have appendectomies and get discharged in two or three days. I’ve been half a month and still no improvement.”

“I’ll take a look,” Luo said soothingly.

His hands warmed from rubbing, he even checked the temperature on his own neck before proceeding.

On exam, the patient had marked tenderness in the right lower abdomen with pressure pain. No rebound tenderness or muscle guarding.

The diagnostic AI finally gathered enough data and suggested—abdominal 64-slice CT scan.

Luo was puzzled but didn’t show it; instead, he gave Lin a meaningful look.

Many things couldn’t be said in front of the patient.

Lin said nothing, his face serious as he returned to the office.

“Director Lin, I recommend a 64-slice abdominal CT.”

“Hm? For what?”

“To complete the intestinal exam and rule out related diseases.”

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“Diseases of the liver, gallbladder, pancreas? Impossible. Ultrasound was done pre-op; the patient only has mild fatty liver,” Chen Yong grumbled.

Wearing a mask gave Chen a strange, muffled impression.

Lin glanced at him without questioning Luo’s decision and made the call, “Do it. I’ll notify the CT director to schedule it early—before lunch. Dr. Chen, you explain it to the family.”

Chen’s delicate eyebrows twitched thrice.

His face, visible beyond the mask, looked troubled. “Director Lin, how should I explain?”

“Do I have to teach you how to speak? Want me to take your shift?” Lin glared coldly.

Lin disliked everyone in General Surgery, even the floor tiles seemed evil to him. He was itching to stomp on them.

He bore a grudge against Director Wen for his dirty tactics.

Although he knew it was prejudice, he didn’t care.

Would a medical affairs director care about a junior doctor’s opinion?

Not at all.

Not even a renowned provincial physician like Wen Youren impressed Lin.

Chen stiffened his neck, about to argue, when Luo intervened: “Just say it’s a consultation requested by experts from Provincial Medical University No. 1. That makes it easier to explain.”

“!!!” Chen was stunned at Luo’s brazen fabrication.

“Director Lin, shall we head back? I’ll check the machine first,” Luo glanced at the time and said to Chen, “Scan at 7:30. Don’t delay; other patients will be unhappy.”

…

An hour later, Chen had communicated with the patient and family.

He first reported to Director Wen, then nervously explained things to the family, using all his skills to barely get by.

As time passed, the patient and family’s patience wore thin; their complaints simmered like a hornet’s nest ready to explode at any moment.

The medical affairs office was just making trouble; aside from a few upper abdominal organs, the 64-slice CT was mostly useless.

Director Lin spoiled Luo too much.

Especially since the family was on the verge of snapping, needing only a small spark to ignite a fire that would consume everything.

When Chen reported to Director Wen, he seemed indifferent.

Chen was puzzled. There was something off.

With 20 minutes left before the scan, Chen avoided rushing the patient and retreated to the duty room to call Jiang Wenming.

“Master,” Chen briefly recounted the morning’s events.

“What do you think is going on?”

“Oh, I see.”

Jiang sounded like he was brushing his teeth, muffled.

“Master, I don’t get it. Director Wen is indifferent. Director Lin brought Luo early to see the patient but listens to Luo’s unreliable advice. Is no one concerned about patients anymore?”

Chen complained angrily.

“Calm down,” Jiang spat water out, speaking more clearly.

“How many times have I told you not to be so hot-headed? Yes, you might not understand ‘hot-headed,’ but it used to be common. Don’t be cynical about everything; analyze calmly.”

“But…”

“Remember the patient with the liver cyst?”

“Yes.”

“That was a big deal, but Director Lin didn’t lose his temper. From what I know, he’s not easygoing.”

“Is the patient yours?”

“No.”

“Good. Write down all treatments and disease progression from last night and this morning in detail. And!”

Jiang emphasized,

“Shifting blame will happen; just don’t take the blame yourself. Chen Yong, you must list who approved each treatment. Don’t mention Luo; he’s too young to handle trouble. Attribute orders to Director Lin and approval by Director Wen.”

Chen hesitated.

Was such detail necessary?

“After the scan, finish the records. Remember: be thorough! Even if verbose, don’t leave anything out. Not just this case; be careful with all patients and treatments in recent months.”

“Why?”

“To avoid getting blood on yourself.”

“Uh, okay, Master.”

“Come to the clinic after you’re done; I’ll explain. It’s early morning, and I haven’t eaten.”

Chen sighed. “Master, please come back. I think you’re the only decent doctor in the department.”

“My novel is about to launch on TikTok promotion; the editor wants more updates. When would I have time for patients? Besides, does the Earth stop spinning without me? Come see me when you’re free; I’ll explain everything.”

Jiang hung up.

Chen stared at his phone, listening to the “beep beep beep” sounds, lost in thought.

This was unlike what he had imagined.

Could this be a standoff between Director Lin and Director Wen? Chen wondered.

Time came, and Chen escorted the patient to the CT room.

From afar, he saw Director Lin and Luo inside the control room.

Director Lin seemed to take this seriously; Chen noted everything carefully.

“Little Screw, what do you think the problem is?”

“An intestinal issue. The initial diagnosis was partly right, partly wrong.”

“What do you mean?” Lin asked.

Luo’s words sounded cryptic.

“Let’s do the scan first,” Luo said.

All was speculation based on the diagnostic AI’s suggestion; Luo was following that line of thought, seeing some clues.

But he wasn’t certain.

After placing an IV needle and skin test, medication would be administered 15 minutes later.

One frame after another from the 64-slice CT appeared on the screen.

Soon, Lin spotted the “problem”!

Having graduated with a degree in imaging, Lin was among the elite of his time, unlike the students after mass expansions.

There was an abnormal image in the patient’s colon!

“Director Lin, here,” Luo pointed to the screen. “It’s not a tumor, but a colonic lipoma.”

“Colon? Lipoma?!” Lin was puzzled.

“At the cecum, there’s a 6 cm intraluminal lesion, with clear borders, uniform fat density, no solid components. This mass causes partial colonic obstruction. I diagnose cecal lipoma.”

Luo glanced at the system panel; the diagnostic AI had already given a definite diagnosis.

“Colon wall thickening with fold edema suggests pseudomembranous colitis,” he added.

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“The intraluminal lipoma in the ileocecal region causes partial bowel obstruction and inflammation, which triggered the appendicitis?”

Lin cautiously asked.

At this moment, he instinctively realized his clinical experience was inferior to his nephew’s.

“Yes,” Luo smiled. “So the diagnosis of acute appendicitis was partly right and partly wrong.”

Lin’s mind opened up.

He already had ideas on how to proceed.

Chen stared at the abnormal “mass” on the screen, stunned. He never expected the 64-slice CT would reveal the problem so clearly.

Normally, no one would order such a scan for acute appendicitis; even if the patient returned, misdiagnosis would be likely.

Rare diseases were not something district hospitals usually diagnosed—encountering one was just unlucky.

If every patient underwent exhaustive testing, doctors would be inundated with complaints before finding a single rare case.

Luo was impressive, Chen thought, watching him intently.

Luo, however, seemed unaware, staring at the screen without knowing what he was doing.

“Luo Hao, what’s next?”

“There are a few options. First, laparoscopic exploration with limited segmental cecal resection plus appendectomy.”

Lin frowned thoughtfully.

“Since the patient had an appendectomy two weeks ago, I don’t recommend a second surgery.”

“Make it simpler,” Lin whispered.

“Second, I suggest endoscopic removal.”

“Anything else?”

“Not for now.”

Lin appeared contemplative and asked no more.

Chen returned the patient alone. During rounds, Director Wen barely glanced at the patient, passing by as if invisible.

Chen had no chance to report the diagnosis.

Something felt off—definitely off!

After handing over to the ward doctor, Chen began writing the medical record notes as Jiang advised.

He was meticulous, even verbose.

After finishing, he reviewed it twice before going to the clinic to find Jiang.

The clinic was busy; Jiang was occupied until lunch break when he finally took a sip of water.

Chen closed the door. “Master, I’m here.”

“I see you,” Jiang already had the inpatient workstation open and was explaining the patient’s record line by line.

“Master, is it necessary to be this detailed? It seems futile.”

“Yes,” Jiang said calmly. “Don’t you feel the storm is coming?”

“Haha, Master, you’re overthinking.”

“No, follow my instructions. Watch this carefully from afar. Be careful not to get splattered with blood—that’s no joke.”

“!!!”

“By the way, you said the diagnosis was from Luo Hao?”

“Yes.”

“This kid’s good. No wonder a doctor who completed eight years of continuous undergraduate and graduate studies at Xiehe Medical University is so strong. Impressive.”

“Well… it’s not that difficult. If I could order tests freely, I could do it too,” Chen muttered.

“You could?” Jiang teased, though it sounded more like talking to himself than mocking Chen.

“Here’s the situation.”

Jiang picked up a pen, took an A4 sheet from the printer, and began mapping out the timeline, explaining the past, present, and his predictions to Chen.

…

“Director Lin, what shall we do about this?” Luo asked, following Lin.

“I’ll handle the next steps,” Lin replied calmly but suddenly paused and looked back at Luo.

Facing Lin’s gaze, Luo sensed there was a serious matter.

“Little Screw, you know how Director Wen feels about experts performing surgery here, right?”

“Yes. He disapproves and even secretly caused the family to file complaints.”

“What do you think we should do?”

Lin’s question made Luo ponder deeply.

Hospital politics were far from Luo’s experience, and the system lacked such knowledge.

Luo knew his uncle was sharpening his knives, ready to teach Wen Youren a lesson.

But how to proceed? Even at Xiehe Medical School, no one taught him this. His mind was blank.

“That’s…”

Back in the office, Lin picked up a pen and pulled another A4 sheet from the printer, marking key points along the timeline.

“There’s tremendous pressure from insurance now. Many surgeries done by old methods cause hospitals to run at a loss. There’s only one solution!”

“Uncle,” Luo tentatively addressed him, seeing no reaction. He realized Lin spoke as family elder, not medical affairs director.

“Shouldn’t the government increase funding to fix this?” Luo asked.

“Ha,” Lin smiled.

“The medical industry is neglected. But if others don’t care, we doctors should. We deal with lives. So we can’t just complain. If conditions allow, we treat. If not, we don’t operate?”

“Uh…”

Luo hadn’t expected his uncle to go so high-minded, leaving him speechless.

“Think I’ve lost it?” Lin teased.

“No, no, you’re right!” Luo answered cheerfully.

“The environment is as it is; we’re doctors and must honor the white coat. Times have changed; we must modernize.”

“Take this patient. Even if Director Wen hadn’t misdiagnosed, how much would that limited cecal resection plus appendectomy cost?”

“How much for a polypectomy by colonoscopy?”

“Uncle, that’s not a polyp,” Luo emphasized.

“I just checked. The head of Gastroenterology at Medical University No. 1 said it’s doable—treat it like a large polyp. Risks are there but worth the gamble.”

Luo glanced at the system panel; he could perform it himself.

Though a 6 cm lipoma in the ileocecal region is very challenging endoscopically, it’s within his “capabilities.”

“Such a procedure costs at most 8,000 yuan, using the best titanium clips.”

“I want to knock some sense into Wen Youren—not out of personal grudge, but to show him that times have changed.”

Lin looked at Luo seriously. “If I put you in General Surgery, can you put down Wen Youren’s arrogance?”

Luo met Lin’s gaze, trying to read his true thoughts.