Haicheng, the night of appendicitis, Zheng Ren has received sufficient training in appendectomy in the system space.
Appendectomy is the foundation, the foundation of surgery.
Zheng Ren's foundation was extremely solid, enough to support a tall building.
But even so, Zheng Ren couldn't guarantee that he would be able to perform the appendix surgery in front of him.
Standing in front of the operating table, Zheng Ren thought for a while and carefully chose a large direct incision of 10cm on the right side of the rectus abdominis.
After opening the peritoneum, Zheng Ren also started to rub his intestines.
Because he was worried that he would indulge too much and make a big mistake outside one day, Zheng Ren habitually followed routine operations cautiously in the system space.
Ten minutes later, Zheng Ren sighed.
He knew what situation Director Wei encountered, there was no appendix!
I checked my intestines and couldn't find the appendix at all!
Zheng Ren would rather encounter Fan Tianshui's kind of gangrenous appendicitis, or Wu Hui's kind of appendicitis that was not removed after one removal, than this kind of appendicitis.
He carefully looked at the system panel again, and the diagnosis was very clear. It was indeed acute simple appendicitis.
Yes, but where is the appendix? !
Let's do an autopsy, we can only use the last big weapon.
Zheng Ren did not hesitate and took a look around to make sure there were no assistants or anesthesiologists, and the environment was also a system operating room.
What's in front of me is the experimental subject, not the patient.
He raised the knife and began to dissect the experimental subject.
After 15 minutes, Zheng Ren felt like he was going crazy.
Operating table... On the dissecting table, the intestines were completely turned out, and the appendix could not be seen under direct vision. The peritoneum is intact, there is no peritoneal tear, and there is no possibility of the appendix herniating into the retroperitoneum.
There are no inguinal hernias, etc.
Simple and standard anatomy, there is no appendix.
The operation failed.
Appendicitis, the operation failed!
Zheng Ren was a little frustrated.
He recalled what Director Luo had just said: Don't just look at the gastrointestinal endoscopy, you should go all out every time.
Even so, mistakes cannot be avoided.
My level of general surgery is already at the master level, and there is a systematic operating room that allows me to perform dissections directly.
Even then, the appendix could not be found.
He sighed, calmed down his irritable mood, and chose another surgery.
The dissected experimental subject disappeared, and another experimental subject appeared in front of him.
Zheng Ren was not in a hurry to have another operation, but quietly recalled it.
Various literature reports and various case analyses.
A revolving door of cases flashed through his mind, and Zheng Ren suddenly thought of a possibility - intracavitary appendix.
Intracavitary appendix means that the appendix does not grow to the outside, but grows into the cecum.
The cecum is the initial section of the large intestine and the shortest section of the large intestine. It is about 6-8cm long and is located in the lower right part of the abdominal cavity.
There is the ileocecal valve at the junction with the ileum, and the cecum is below it. There is a hole connected to the appendix, and then it continues downward to the ascending colon.
This is the beginning of the large intestine, which is pouch-shaped and located in the right iliac fossa and is connected to the ileum. The mucosa at the entrance of the ileum leading to the cecum protrudes into the intestinal lumen, forming upper and lower lip-shaped ileocecal valves, which prevent the contents of the large intestine from flowing back into the small intestine.
In many places, especially in Xiangjiang, appendicitis is called appendicitis because of this anatomical structure.
Intraluminal appendix means that the appendix is not free outside the cecum, but grows abnormally inside the cecum.
This kind of appendix usually causes the cecum to narrow and cause intestinal obstruction.
And the probability of its occurrence is not high. Even if some individual cases are reported, the overall number is very small.
A sudden flash of inspiration allowed Zheng Ren to find a new direction.
He thought for a while, he had already dissected the experimental subject and had not seen the appendix yet. An intracavitary appendix was the only possibility.
Then open it and take a look.
When we came to the experimental subject, we still made the same vertical incision on the right side of the rectus abdominis, 10cm, and cut into the abdomen layer by layer to find the location of the cecum.
Zheng Ren touched it with his hand first.
There was no evidence of the presence of an intraluminal appendix in the cecal end of the intestine.
But Zheng Ren didn't give up and started to touch his intestines upwards.
On the outside operating table, this kind of operation should be avoided as much as possible. Because the intestinal mucosa is damaged, it will increase the possibility of postoperative intestinal adhesions and intestinal obstruction.
But in the system operating room, Zheng Ren had no such scruples.
The ileocecal part was upward, and after touching for about 12cm, Zheng Ren touched a foreign object.
Normally, this should be an object like feces. But for Zheng Ren, who couldn't find his appendix, this was the clearest hint.
After pinching it, Zheng Ren felt more confident.
He then took a lancet and cut open the appendix.
As the intestines were cut open, the elusive appendix appeared in view. It was like a small bug, lying obediently at the end of the cecum, slightly edematous.
Now Zheng Ren's heart had a place to go and fell to the ground.
He carefully observed the appendix. In terms of size, the patient's appendix was relatively small, which was probably the reason why it did not cause intestinal obstruction.
There is a little bit of pus on the surface of the appendix, and it is congested and edematous. It is still early and it is estimated that it will take at least 2-3 days for perforation to occur.
But how to cut it
Zheng Ren was a little confused.
It's not like the appendix is outside the cecum, cut off, ligated, pay attention to the appendiceal artery, and then you're done.
Now the appendix is inside the cecum, and the intestine is reflected, so it is still difficult to remove it after incision.
Give it a try.
Zheng Ren began training to remove the appendix.
It seemed that he had returned to the time when the system space was unstable. Zheng Ren returned to the starting point and began to study appendectomy again.
…
…
"Boss Zheng, can you come up and take a look?" Feng Jianguo asked in a low voice.
"How long should the patient fast before surgery?" Zheng Ren suddenly asked.
"Six hours." Another professor in charge whispered.
"Routine, no enema."
"Yeah." The two leading professors and Director Wei were a little confused. Boss Zheng was asking so many questions.
"If you can't find it, it may be an intraluminal appendix. It's best to use a colonoscope to take a look. But there is no enema..." Although Zheng Ren has determined that it is an intraluminal appendix, he still has to give someone a reason.
Director Wei's heart moved and he said: "Boss Zheng, I've touched it. There is no intracavitary appendix 6-8cm above and below the ileocecal part."
What a wealth of experience, Zheng Ren thought to himself. It's just that this patient's appendix is in a very special position, far away from the ileocecal part, so Director Wei couldn't touch it.
If there wasn't a systematic operating room and I could explore without restraint, I probably wouldn't have been able to find the location of the appendix in this cavity.
Thinking of this, Zheng Ren asked: "Director Wei, have you searched for the intestines?"
"Yeah." Director Wei nodded.
"What about the retroperitoneum?"
"There's no hernia orifice, it's not a retroperitoneal appendix." Director Wei sighed, as if what Boss Zheng said was of no use.
Zheng Ren looked at the surgical area and said, "Everything has been turned over. I think there is a high possibility of an intracavitary appendix. How about using a colonoscope to observe it?"
"Colonoscopy?!" Director Wei was startled.
"Well, under the premise that the diagnosis is correct, I have searched the abdominal cavity and still can't see the appendix. It is more likely that the appendix is in the cavity, maybe due to position variation. It is recommended to use a colonoscopy to see if it is still there. If we can’t find it, let’s find another way.”
After saying that, he glanced at Director Wei and asked, "What do you think, Director Wei?"
"Prepare for intraoperative enema!" Director Wei agreed with Zheng Ren's statement. He was a little excited and said directly: "Tour?"
The circulating nurse was dumbfounded.
Do you need an intraoperative enema? How troublesome this is.
Trouble is a trivial matter, but what could be more troublesome than a “missing” appendix
The patient's position, the sterile field, and the enema operation... what to do with the feces
"Wait a moment, Director Wei." Zheng Ren said: "How many days did the patient have pain before the operation?"
"Three days." Another professor who led the team said, "The diet is liquid food, small amount. It should be... that it is almost done."
"Try a colonoscopy, without enema first. You don't need to do anything with the colonoscopy, just take a look. If there are lumps of feces, it's still too late to do an enema." Zheng Rendao.
The traveling nurse breathed a sigh of relief.
"I'm going to do a colonoscopy." Feng Jianguo said.
"Director Luo came up with me. It's probably coming soon. Let Director Luo do it." Zheng Ren was about to wash his hands and said back.
Director Luo? What is he here for