Chapter 1500 Intracavitary Appendix

Haicheng, the night of appendicitis, Zheng Ren has received adequate training in appendectomy in the system space.

Appendectomy is the foundation, the foundation of surgery.

Zheng Ren's foundation was extremely solid, enough to hold up a ten-thousand-zhang tall building.

But even so, Zheng Ren couldn't guarantee that he would be able to get the appendix surgery in front of him.

Standing in front of the operating table, Zheng Ren thought for a while, and cautiously chose the right side rectus abdominis incision, a direct large incision, 10cm.

After opening the peritoneum, Zheng Ren began to stroke his intestines.

Because he was worried that he would indulge so much that he would make big mistakes outside one day, Zheng Ren was habitually operating in the system space and cautiously followed the routine operation.

Ten minutes later, Zheng Ren sighed.

He knew what happened to Director Wei, there was no appendix!

I stroked my intestines again, but I didn't find the appendix at all!

Zheng Ren would rather encounter Fan Tianshui's gangrenous appendicitis, or Wu Hui's appendicitis that was not cut out after a single excision, rather than touching this kind of appendicitis.

He carefully looked at the system panel again, the diagnosis was very clear, it was indeed acute simple appendicitis.

Yes, but where is the appendix? !

Anatomy, only the last big killer can be used.

Without hesitation, Zheng Ren glanced around and determined that there were no assistants, no anesthesiologists, and the environment was also a system operating room.

In front of them are the experimental subjects, not the patients.

He raised his hand and dropped the knife, and began to dissect the experimental body.

After 15 minutes, Zheng Ren felt like he was going crazy.

The operating table... On the dissection table, the intestines were completely turned out, and the appendix was not visible under direct vision. The peritoneum is intact, there is no peritoneal hiatus, and the appendix may herniate into the retroperitoneum.

No inguinal hernia etc.

Simple and standard anatomy, that is, there is no appendix.

The operation failed.

Appendicitis, surgery failed!

Zheng Ren was a little frustrated.

He recalled what Director Luo said just now, regardless of the simplicity of gastroenteroscopy, he did his best every time he did it.

Even so, mistakes cannot be avoided.

His general surgery level is already at the level of a master, and there is a systematic operating room that allows him to perform anatomy directly.

Even if you open the hook, you may not find the appendix.

He sighed, calmed down his irritable mood, and ordered another operation.

The dissected experimental body disappeared, and another experimental body appeared in front of him.

Zheng Ren was not in a hurry to perform the operation again, but quietly recalled.

Various literature reports, various case studies.

Cases like a revolving lantern flashed in his mind, and Zheng Ren suddenly thought of a possibility - an appendix in the cavity.

Intraluminal appendix means that the appendix does not grow outside, but inside the cecum.

The cecum, the initial segment of the large intestine and the shortest segment in the large intestine, is about 6-8 cm long and is located in the lower right part of the abdominal cavity.

At the junction with the ileum, there is the ileocecal valve, below which is the cecum, which is connected to the appendix by a hole, and then continues down to the ascending colon.

This is the beginning of the large intestine, which is pouch-shaped and located in the right iliac fossa, where it joins the ileum. The mucosa at the entrance of the ileum 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 the Xiangjiang area, appendicitis is called appendicitis because of this anatomical structure.

Intraluminal appendix is ​​the appendix that is not free outside the cecum, but grows abnormally inside the cecum.

This appendix usually leads to narrowing of the cecum, resulting in intestinal obstruction.

And the probability of it appearing is not high, even if there are some case reports, the overall number is very small.

An instant flash of inspiration made Zheng Ren find a new direction.

He thought about it for a while, and he had done the dissection of the experimental body, and he had not seen the appendix yet, and the appendix in the cavity was the only possibility.

Then open it up.

Before coming to the experimental body, the vertical incision next to the right rectus abdominis was still made, 10 cm, and the abdomen was incised layer by layer to find the location of the cecum.

Zheng Ren first touched it with his hand.

There is no evidence of the presence of an intraluminal appendix in the cecal-end bowel.

But Zheng Ren didn't give up and started to touch his intestines upwards.

On the operating table outside, this operation is to be avoided as much as possible. Because of the damage to the intestinal mucosa, it will increase the possibility of postoperative intestinal adhesions and intestinal obstruction.

But in the operating room of the system, Zheng Ren had no such scruples.

The ileocecal area was upward, and he touched about 12cm. Zheng Rencai vaguely touched a foreign object.

Normally, there should be something like feces here. But for Zheng Ren, who couldn't find his appendix, this was the clearest hint.

I squeezed it hard, regardless of whether there will be intestinal obstruction after the operation, after all, it is an experimental subject, and the strength is a bit presumptuous. This time, Zheng Ren felt more confident.

He then took the lancet and cut open the section of the cecum.

As the intestines were cut open, the elusive appendix came into view. It was like a small bug, lying obediently at the end of the cecum, slightly edema.

Now Zheng Ren's heart had a place to go, and it 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 for not causing intestinal obstruction.

There is a little pus on the surface of the appendix, congestion and edema. It is still early, and it is estimated that it will take at least 2-3 days for perforation to appear.

But how to cut it?

Zheng Ren was a little confused.

It's not like the appendix is ​​outside the cecum, cut, ligated, pay attention to the appendix artery, and then it's done.

Now that the appendix is ​​in the cecum, and the intestines are reflexed, it is still difficult to remove the appendix after incision.

Give it a try.

Zheng Ren started training to cut the appendix.

It seems to have returned to the time when the system space was unstable, Zheng Ren returned to the original point, and began to study appendectomy again.

...

...

"Boss Zheng, can you come and take a look?" Feng Jianguo asked in a low voice.

"How long did the patient fast for water before surgery?" Zheng Ren asked suddenly.

"Six hours." Another professor who led the group whispered.

"Routine, no enema."

"Yeah." The two leading professors and Director Wei were a little puzzled, and Boss Zheng asked so many questions.

"If you can't find it, it may be an intracavitary appendix. It's best to take a look at it with a colonoscope. But there is no enema..." Although Zheng Ren has already determined that it is an intracavitary appendix, but to open the intestine, he must always give people a reason.

Director Wei moved in his heart and said, "Boss Zheng, I have touched it. There is no appendix in the cavity 6-8cm above and below the ileocecal region."

The experience is really rich, Zheng Ren thought to himself. It's just that this patient's appendix is ​​in a very special position, far away from the ileocecal area, so Director Wei didn't touch it.

If it weren't for the systematic operating room, if I could explore without restraint, I wouldn't be able to find the place where the appendix exists in this cavity.

Thinking of this, Zheng Ren asked, "Director Wei, you've already found your intestines, right?"

"Well." Director Wei nodded.

"What about the retroperitoneum?"

"There is no hernia, not a retroperitoneal appendix." Director Wei sighed, it seemed that what Boss Zheng said was useless.

Zheng Ren glanced at the surgery area and said, "It's already been turned over. I think there is a high possibility of an intracavitary appendix. Or, take a look at it with a colonoscope?"

"Enteroscopy?!" Director Wei was startled.

"Well, under the premise that there is no problem with the diagnosis, I have searched the abdominal cavity, but I still can't see the appendix. Considering the possibility of the appendix in the cavity is relatively large, maybe the position may vary. It is recommended to use a colonoscopy. If we can't find it, let's think of another way."

After speaking, he glanced at Director Wei and asked, "What do you think, Director Wei?"

"Prepare for an intraoperative enema!" Director Wei agreed with Zheng Ren's statement. He was a little excited and said directly, "Tour?"

The itinerant nurse was dumbfounded.

Intraoperative enema? What a hassle.

Trouble is trivial, and what could be more troublesome than a "missing" appendix?

The patient's position, the sterile area, plus the operation of the enema... What should I do with the things that come out?

"Wait a minute, Director Wei." Zheng Ren said, "How many days did the patient have pain before the operation?"

"Three days." Another professor who led the group said, "The diet is liquid food, and the amount is small. It should be... the stool is almost discharged."

"Try a colonoscopy, don't do an enema first. You don't need to do any operations with a colonoscopy, just take a look. If there is lumps of feces, it's too late for an enema." Zheng Ren said.

The itinerant nurse let out a long breath.

"I'm going to do a colonoscopy." Feng Jianguo said.

"Director Luo and I came up together. It is estimated that it is almost here. Let Director Luo do it." Zheng Ren turned around and said as he prepared to brush his hands.

Director Luo? What is he doing here?