[MHS: Episode-75] Part III: The Crossroads Between Life and Death
[MHS: Medical Human Story]-Episode 75
Prologue | Part 1 | Part 2 | Part 3 | Part 4 & Epilogue
Part III: The Crossroads Between Life and Death
"Surgery was a choice. But time refused to give him one."
"Every emergency surgery appears to begin suddenly. Yet most begin at
the moment when countless small warning signs, ignored for years, finally reach
their breaking point."
Two Consent Forms and the Weight of Silence: The
Conflict in the Surgical Consultation Room
The atmosphere inside the surgical consultation room felt unusually heavy
and cold.
Min-jun sat silently, staring at his own abdominal CT images rotating
continuously on the monitor screen.
Like many patients who see the internal structure of their own bodies for
the first time, he was less focused on the unfamiliar geometric patterns of
cross-sectional imaging and more focused on the expression and eyes of the
surgeon sitting across the desk.
He repeatedly glanced toward the surgeon, searching for an answer hidden
in his face.
"Professor... do I really need surgery right now?"
His voice trembled with desperation.
"I'm still young... Can't we try medication and observation
first?"
The attending surgeon did not answer immediately.
He adjusted his glasses and remained silent for a moment.
The ticking sound of the clock on the consultation room wall suddenly
seemed unusually loud.
Finally, he spoke.
"Min-jun, I want to be completely honest with you. Your intestine is
not currently in a state of complete necrosis. The blood supply is still
preserved."
For a brief moment, the tension on Min-jun's face loosened.
A faint expression of relief appeared.
But the surgeon's next words immediately brought him back to reality.
"However, that does not mean your condition is safe. That would be a
dangerous misunderstanding."
The surgeon moved the mouse and pointed toward the three-dimensional
reconstructed CT images.
"In normal human anatomy, the intestines follow a specific
developmental process. They rotate and become fixed in their proper positions
within the abdominal cavity."
"But in your case, during fetal development, the midgut failed to
complete the normal 270-degree rotation and fixation process."
"Because of this abnormality, a congenital fibrous structure called a
Ladd's band has been compressing your duodenum, causing repeated episodes of
partial obstruction and vomiting throughout your life."
The surgeon looked directly into Min-jun's eyes.
"Can we guarantee that this condition will remain stable
forever?"
He paused.
"No."
"At some point, during eating or simply due to changes in intestinal
movement, your bowel may suddenly twist completely."
"This can progress into an acute midgut volvulus."
"And when that happens, there may be no opportunity for a planned
decision. It can rapidly lead to intestinal necrosis, sepsis, and a
life-threatening emergency."
Silence filled the room again.
Min-jun could no longer speak.
He simply stared at the white surgical consent forms placed in front of
him.
Two pieces of paper.
Two signatures.
And a decision that would change his entire life.
A Mother's Tears and the Axis of Memory: The Weight
of Years Already Passed
In the hospital room, Min-jun's mother sat beside his bed, tightly holding
his hand.
Her rough, weathered palm carried the invisible weight of decades spent
raising her son.
The weight of love.
The weight of worry.
And perhaps the weight of guilt.
"Since you were little..."
Her voice trembled.
"Whenever you vomited like that, I thought you simply had a weak
stomach. I didn't know any better. I should have taken you to a bigger hospital
earlier."
"If I had looked into it sooner, maybe you wouldn't have suffered
like this..."
Tears fell onto her son's hand.
One drop after another.
Min-jun forced himself to smile calmly.
He gently comforted his mother.
"Mom, what are you talking about?"
"This is how my body was made. How could this possibly be your
fault?"
"Just like it isn't my fault, it isn't yours either."
But behind his reassuring words, memories from the past began flooding
through his mind.
Like scenes from an old film playing rapidly before his eyes.
The infant who vomited violently after drinking milk.
The child who could barely tolerate solid food.
The student who suffered severe abdominal pain before important exams and
school events.
The young soldier who spent nights in emergency rooms receiving
intravenous fluids while covered in cold sweat.
The office worker who carried digestive medication and antacids
everywhere, constantly searching for the nearest restroom.
Every fragmented memory.
Every unexplained episode.
Every moment of suffering.
Finally connected into one complete story.
Disease is never only the physical suffering of the patient.
A family that watches helplessly for years, sharing the fear and tears,
also fights an invisible battle alongside the patient.
The Last Meal and the Breaking Point: Calm Before
the Storm
One or two days before surgery, warm sunlight entered through the hospital
room window.
The peaceful scenery outside seemed strangely disconnected from the fear
inside.
Min-jun stared outside for a long time.
Then he carefully spoke to his nurse and attending physician.
"Can I ask something?"
"Do I really have to undergo surgery today?"
"What if I just go home, observe for a while, and decide later if
things become worse?"
His voice was filled with fear.
Fear of the operating room.
Fear of changing the body he had lived with for 32 years.
Although abnormal, this body had somehow survived.
It had adapted.
It had endured.
The thought of allowing surgeons to cut into it and rearrange everything
felt terrifying.
A small hope remained inside him:
Maybe if he rested for a few days...
Maybe if he took medication...
Maybe everything would return to normal again.
But that hope lasted only a few minutes.
Suddenly—
A sharp pain exploded through his upper abdomen.
Like a blade stabbing directly into his epigastrium.
His face immediately turned pale.
His lips lost all color.
He grabbed the bedsheet tightly and curled forward, clutching his abdomen.
His breathing became rapid and shallow.
Then came the vomiting.
Not the familiar episodes he had endured for years.
This was different.
A violent, uncontrollable force driven by extreme internal pressure.
A terrifying episode unlike anything before.
It felt as if his intestine itself had reached its limit.
As if his body was screaming its final warning.
Emergency Response and Clinical Judgment: A Race
Against Time
"Emergency call! Resident team to the ward immediately!"
The emergency alarm beside the hospital bed rang loudly.
The nurse rushed into the room.
Surgical residents and fellows immediately followed.
An urgent abdominal examination was performed.
His abdomen was severely distended, tense like a drum.
When the team listened with a stethoscope, bowel sounds were barely
audible.
A sign suggesting that this was no longer simple indigestion.
The obstruction and possible compromise of intestinal blood flow had
reached a critical stage.
I immediately opened the PACS system and reviewed Min-jun's abdominal CT
again.
The anatomical abnormalities on the images appeared almost unchanged from
the previous day.
But the meaning of those images had changed.
Because the patient lying in front of us was changing.
Rapidly.
"Imaging shows the anatomy from a moment in time."
"But the decision for surgery is completed only when we combine those
anatomical findings with the patient's current clinical deterioration."
This was the true essence of modern medicine.
Precise.
Cold when necessary.
But deeply human.
There was no longer room for delay.
If the operating room was not opened immediately, intestinal ischemia and
complete bowel necrosis could become reality.
The Final Smile Before Surgery: The Border Between
Despair and Hope
Min-jun was transferred onto the operating bed.
Wearing a blue surgical gown and cap, he moved down the cold hospital
corridor toward the operating room.
Just before the automatic doors opened, someone rushed toward him.
It was Ji-eun.
She had been waiting silently in the corner of the waiting area.
She grabbed his trembling hands tightly with both of hers.
Their eyes were filled with fear.
With worry.
But Ji-eun swallowed her tears and tried to smile.
"Min-jun... are you scared?"
Min-jun smiled weakly.
His face was pale.
He nodded.
"Yes..."
"I'm really scared."
Ji-eun squeezed his hand.
"Me too."
"So you have to come back safely."
For a brief moment, a painful but tender smile appeared on both of their
faces.
That small exchange was the last ordinary moment they could share before
entering the storm of major surgery.
The operating room doors closed.
Min-jun disappeared from sight.
Ji-eun collapsed into the waiting chair and covered her face with both
hands.
The Battle Inside the Operating Room and Anatomical
Restoration: A Miracle Emerging from the Edge of the Scalpel
Inside the operating room, the surgical lights emitted the same cold and
brilliant illumination they always had.
But beneath that intense light, every decision made by the surgeon and
every movement of the surgical team carried a weight beyond measure.
Every second mattered.
Every action carried consequences.
With a precise incision using advanced surgical instruments, the abdominal
cavity was carefully opened and the internal structures were exposed.
The congenital abnormality that had only been suspected through CT imaging
was finally revealed directly before their eyes.
The reality was even more striking than the images had suggested.
The intestines had completely deviated from their normal anatomical
positions.
They were twisted and abnormally arranged.
The cecum was located far above its expected position, deeply embedded in
the upper abdomen.
And crossing over the lower portion of the duodenum was the dense fibrous
structure responsible for years of suffering:
the Ladd's band.
The surgeon spoke calmly and firmly.
"Begin Ladd's band division."
"Release the duodenal compression."
"Be careful not to injure the surrounding vessels."
Following the surgeon's precise instructions, the operative team carefully
dissected the abnormal fibrous attachments using delicate microsurgical
instruments.
Every movement was controlled.
Every layer was separated with patience.
The goal was simple:
Remove the obstruction.
Restore normal anatomy.
Protect the intestine.
After safely releasing the Ladd's band, the surgeons proceeded with the
next critical step.
The abnormally positioned bowel loops were carefully mobilized and
rearranged.
The small intestine and colon, which had remained twisted and displaced
for 32 years, were placed into a more functional anatomical arrangement.
This procedure, known as the Ladd procedure, represented the
standard surgical correction for intestinal malrotation.
When the anatomical correction was completed, the surgeon performed a
final assessment.
Using specialized illumination equipment, the team carefully examined:
- The color of the
intestinal walls
- The presence of adequate
blood flow
- Signs of ischemia or
tissue damage
Everyone in the operating room waited silently.
Fortunately, because surgery had been performed before irreversible damage
occurred, the intestine remained viable.
There was:
- No evidence of severe
intestinal ischemia
- No irreversible bowel
necrosis
- No need for extensive
bowel resection
The vital signs displayed on the operating room monitors gradually stabilized.
The rhythm of the alarms became calmer.
The surgical team finally released the tension they had been carrying.
A long breath of relief passed through the room.
According to the clinical findings documented in this case, Min-jun's
years of recurrent vomiting had been caused by:
- Partial
duodenal obstruction due to Ladd's band
- Chronic
intermittent midgut volvulus associated with intestinal malrotation
Fortunately, corrective surgery was successfully performed before
progression to:
- Complete intestinal
obstruction
- Severe vascular
compromise
- Permanent intestinal
ischemia
The disease that had silently controlled his life for 32 years had finally
been confronted.
Not with another medication.
Not with another temporary diagnosis.
But with a direct correction of the hidden anatomical problem itself.
[🩺 Medical Insight] Surgical Management of Adult Intestinal Malrotation: The Role of the Ladd Procedure
Why Early Recognition Matters
Adult intestinal malrotation is not dangerous simply because the anatomy
is unusual.
The real danger lies in the possibility of sudden transformation:
Chronic intermittent obstruction → Acute midgut volvulus → Vascular
compromise → Intestinal necrosis → Life-threatening sepsis
The transition can occur rapidly.
A patient who appears stable one day may become critically ill the next.
The Meaning of Surgery Beyond Anatomy
For Min-jun, the operation was not merely a procedure to correct an
intestinal abnormality.
It was the moment when medicine finally answered a question he had carried
silently for 32 years:
"Why has my body always betrayed me?"
The answer was not weakness.
It was not stress.
It was not a lack of willpower.
It was a hidden anatomical condition that had existed since before he was
born.
And once the truth was revealed, healing could finally begin.
Part II: The Moment of Diagnosis☜ Previous Chapter
Next Chapter ☞Part IV: He Was No Longer Afraid to Eat
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