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The ultrasound by the bedside in the emergency room arrived quickly, and the result didn’t reveal any obvious problems. The appendix, gallbladder, kidneys, and ureters were all fine.

The liver, gallbladder, pancreas, spleen, and kidneys all seemed normal too!

Considering the girl had no history of overeating or binge drinking, and since the pain wasn’t primarily on the left side, it likely wasn’t acute pancreatitis.

Could it be appendicitis?

An acute attack?

Ultrasound can’t detect appendicitis unless it’s a chronic inflammation that’s persisted and formed a severe intraperitoneal inflammatory mass.

Chen Cang continued to inquire in detail about her medical history.

“Have you felt any migrating abdominal pain, like from the upper abdomen gradually moving to the navel area, then to the lower right abdomen?”

The girl seemed to have an issue with Chen Cang; her mood had already soured during their interaction.

Chen Cang was somewhat helpless.

Seeing this, the mother suddenly said, “Ni Ni, speak kindly, cooperate with the doctor’s examination. Would the doctor do you any harm?.”

The girl shook her head: “No, I don’t have that.”

Chen Cang pondered, “Let’s do an abdominal CT scan to see if there’s any chance of appendicitis!”

The girl rolled her eyes at Chen Cang and scoffed, “Are you even competent? Now this, now that, are you trying to scam my family’s money?”

The parents hurriedly apologized, “Sorry, doctor. We’ve actually been wanting to get a physical examination for our child. Just consider it a check-up!”

Fortunately, the parents were cooperating actively, so the examination could continue.

The girl was unwilling, no matter what, but still got dragged by her parents to undergo an abdominal CT scan.

After completing the CT scan, no significant abnormalities were found.

It wasn’t acute appendicitis, nor was there any evidence of bile duct stones, cholecystitis, cholangitis, pancreatitis, intestinal obstruction, gastrointestinal perforation, and so on.

Now, the exact cause of the abdominal pain was even more perplexing.

With such severe abdominal pain, the causes are limited; now the only remaining suspicion was a gastrointestinal issue.

Such as gastric ulcers, and possibly duodenal ulcers. Peptic ulcers are a very common cause of abdominal pain.

However…if an endoscopy was required, Chen Cang was now very concerned about the girl’s lack of cooperation.

And right now, it was truly impossible to diagnose precisely what was going on.

At that moment, the girl’s father’s phone rang. He stepped out to take the call, then came back in a rush, sent off the lab results and imaging data to the caller, and asked Chen Cang some professional questions.

After Chen Cang explained, the man stepped out again with his phone.

A few minutes later, the man came back and said, “Doctor… could you help us check with a gastroscopy and a colonoscopy?”

“Here’s the thing, my child has been having abdominal pain for a while, and I consulted a friend of mine who is a doctor in the capital. He’s a specialist in gastroenterology and suggested I get a gastroscopy and a colonoscopy to check for any changes.”

It’s quite convenient to schedule an endoscopy in the emergency department, as opposed to the gastroenterology department, where you’d have to wait for a scheduled appointment. Although the emergency charges more, it’s also more accessible.

Seeing the girl’s state, Chen Cang suggested an inpatient examination in the gastroenterology department, which could also be partially reimbursed.

But upon hearing about hospitalization, the girl’s parents quickly refused.

They seemed not to care about the money and wanted to get a clear diagnosis as soon as possible.

Endoscopy is quite taxing, and the girl initially resisted, but due to her parents’ insistence, she reluctantly agreed to it.

When the results of the gastroscopy came out, there was a bit of superficial gastritis, but no significant issues. Still, this certainly wasn’t the cause of the abdominal pain.

If the girl could barely accept the gastroscopy, her reaction to the colonoscopy was intense!

Upon considering the colonoscopy, the girl’s mother quickly discussed it with the father.

The two suddenly decided to go through with it!

But before that, the girl’s mother found a female doctor in the endoscopy room prepared to perform the colonoscopy, whispered a few words to her, and sneakily handed over a red envelope, hoping she would also look for any… damage while performing the colonoscopy.

After the colonoscopy, no significant abnormalities were found.

There was no colitis, no pathology in the colon, and certainly no tumors.

Although there were no anomalies, the girl’s mother was clearly upset…

The reason for her anger seemed not to be about the abdominal pain but rather about the female doctor’s report.

“Your daughter might have had something, but…it can’t be assured, as there are many reasons that could lead to damage. So, don’t worry too much.”

After the examinations, the girl’s parents were both quite upset.

But at that moment, the girl suddenly experienced abdominal pain again!

Clutching her stomach, she began to wail.

In the observation room, Chen Cang also ran out of clues.

Essentially, all possible tests had been done.

But still, not a single anomaly was found, which seemed quite unscientific!

Abdominal ultrasound, gynecological ultrasound, abdominal CT, gastroscopy, colonoscopy had all been performed, and yet the cause of the abdominal pain remained a mystery.

There’s only so much in the stomach, and the entire digestive tract is only so long. The gastroscopy looks at the upper part of the digestive tract, and the colonoscopy looks at the lower part.

Could it be… the middle part that isn’t visible is where the problem lies?

That would be the jejunum and ileum of the digestive tract, which are not visible. Could there be a problem there?

Should we do a capsule endoscopy?

Chen Cang now was also very eager to know what kind of evil was at play.

He hadn’t encountered such strange abdominal pain in a long time!

But looking at the girl’s condition at the moment, Chen Cang felt it was serious!

A capsule endoscopy can examine the entire digestive tract by having the patient swallow a camera about the size of a capsule, which travels through the gastrointestinal tract, taking continuous photographs that are transmitted to a computer until it is finally excreted in the stool.

If there is a problem with the small intestine (jejunum, ileum), then the capsule endoscopy can be helpful.

But this test is very expensive!

The endoscopy room at the Second Provincial Hospital can perform it, but it costs several thousand, and though it could be reimbursed for inpatient care, it’s problematic for emergency cases…

Just at that moment, Chen Cang suddenly turned around and spotted the girl’s mouth twitching and her eyes appearing dull and vacant!

!

This frightened Chen Cang greatly!

What was this… what was happening?

However, this condition came in a hurry and left just as swiftly, soon passing.

This signal had Chen Cang shocked.

He suddenly thought of a possibility!

He looked at the girl’s parents, “May I ask… does anyone in the family have epilepsy?”

Upon hearing this, both quickly shook their heads, “No, no epilepsy…”

Chen Cang continued to ask, “Then, has she suffered any trauma? To her head.”

The girl’s father suddenly realized, “Yes, that’s right! In July, during her summer holidays, she fell off her bike and hit her head, she was dizzy for several days. A brain MRI and CT scan showed nothing, so it might have been a mild concussion.

Chen Cang hurriedly said, “I’m now considering the possibility that your daughter’s symptoms might be epilepsy!”

Upon hearing this, the woman was startled!

Epilepsy is no minor ailment!

It’s known as ‘falling sickness’!

Plainly speaking, in the past in the countryside, it was a disease that people scorned and mocked.

Having someone with ‘falling sickness’ in the family… talking about it would make even finding a partner difficult!

Therefore, the woman was quite frightened, “Doctor… you must be joking, right? How could epilepsy cause stomach pain, isn’t it about having convulsions and frothing at the mouth?”

Chen Cang shook his head, “I’m only suspecting it now, because there is a type of epilepsy which primarily manifests as abdominal pain!”

“When an epileptic seizure occurs, it can be accompanied by autonomic nervous system attacks, medically also known as diencephalic epilepsy, with specific variations including headache type, abdominal pain type, limb pain type, syncope type, or cardiovascular type attacks.”

“Therefore, after so many tests, I now suggest we do an electroencephalogram (EEG) to try to find the cause.”

The girl’s parents were quite reasonable and immediately agreed upon hearing this!

Typical epilepsy does indeed involve convulsions, disturbances of consciousness, and frothing at the mouth—this everyone understands.

But atypical epilepsy could present as abdominal pain, because the abnormal discharge in the brain may be related to the disorder in the abdominal nerves, causing abdominal pain.

Although rare, such cases do exist!

Otherwise, they wouldn’t be written about in textbooks.

So, when Chen Cang saw the girl’s absence seizure, he suddenly thought of this possibility.

Such a rare case greatly piqued Chen Cang’s interest.

The parents immediately took their child to the EEG room for an urgent EEG scan.

Compared to an EKG, EEGs take longer, but Chen Cang estimated that if it were epilepsy, it would definitely be detected.

Because the girl had already had several episodes today, and just now, a minor one.

Soon, the results of the EEG were out!

Chen Cang, looking at the waveforms, wasn’t very familiar with the interpretation…

But the examining doctor said, “Doctor Chen, do you see? These 3 cycles/second spike-and-wave complexes, and bilaterally symmetrical at the same time… This is a typical EEG manifestation of an epileptic petit mal seizure!”

At this, Chen Cang was instantly delighted!

Finally, he had found the cause!

An EEG examination plays a decisive role in diagnosing epilepsy.

And now, the truth was laid bare.

Dr. Li Yan from the examination department was somewhat surprised, “This is the first time I’ve encountered such a patient!”

Now that the cause was found, Chen Cang called the neurology department to request a consultation.

Zhang Lingyun, upon hearing this special case history, hurried down.

“Chen, in all my years, I’ve only encountered such a case during my school days! I didn’t expect to see it again!” Zhang Lingyun said with some excitement.

Now that epilepsy was confirmed, Ni Ni’s parents were not concerned about school. They promptly took leave and arranged for her admission to the neurology department.

ps: Writing till two or three in the morning, about 15,000 words, I ask for your support!

I hope to get some likes to help the old hand in the honor battle!

Thank you!

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