Chapter 1501

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

Appendectomy is the basis of surgery.

Zheng Ren's foundation is very solid, enough to support a tall building.

But even so, Zheng Ren can't guarantee that he will be able to take down the appendectomy.

Standing in front of the operating table, Zheng Ren thought and carefully chose the right rectus abdominis incision, direct large incision, 10cm.

Opening the peritoneum, Zheng Ren began to stroke his intestines.

Because he was worried that he indulged too much and would make a big mistake outside one day, Zheng Ren habitually operated cautiously in the system space.

Ten minutes later, Zheng Ren sighed.

He knows what happened to Director Wei. He has no appendix!

I stroked my intestines and didn't find the appendix at all!

Zheng renning would not touch fan Tianshui's gangrenous appendicitis or Wu Hui's appendicitis that was not cut off at one time.

He looked at the system panel again. The diagnosis was very clear. It was indeed acute simple appendicitis.

Yes, but where's the appendix?!

Dissect it. You can only use the last big killer.

Without hesitation, Zheng Ren glanced around and determined that there was no assistant or anesthesiologist, and the environment was also a systematic operating room.

In front of us is the experimental body, not the patient.

Start to dissect the experimental body.

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

Operating table... On the anatomical table, the intestines were completely turned out, and the position of the appendix was not seen under direct vision. The peritoneum is very complete, there is no peritoneal fissure, and the appendiceal hernia may reach the retroperitoneum.

There was no inguinal hernia.

The simple and standard anatomical structure is that there is no appendix.

The operation failed.

Appendicitis, the operation failed!

Zheng Ren is a little depressed.

He recalled what director Luo said just now. Don't look at the gastrointestinal endoscopy. He went all out every time.

Even so, mistakes cannot be avoided.

My general surgery level is already at the master level. In addition, there is a systematic operating room so that I can open anatomy directly.

Even if the hanging force is turned on, the appendix may not be found.

He sighed, calmed his irritability and chose another operation.

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

Zheng Ren was not in a hurry to have another operation, but quietly recalled.

Various literature reports and case analysis.

The case like a horse lantern flashed in his mind. Zheng Ren suddenly thought of a possibility - intracavitary appendix.

Intracavitary appendix means that the appendix does not grow to the outside, but to the inside of the cecum.

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

There is a ileocecal valve at the junction with the ileum, the lower part is the cecum, a hole is connected with the appendix, and then the ascending colon is connected downward.

Here is the beginning of the large intestine, in the shape of a pouch, located in the right iliac fossa and connected with the ileum. The mucosa at the entrance of ileum to cecum protrudes into the intestinal cavity to form upper and lower lip shaped ileocecal valves, which can prevent the contents of 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 does not dissociate outside the cecum, but grows abnormally inside the cecum.

This kind of appendix will generally lead to the narrowing of the cecum and intestinal obstruction.

Moreover, the probability of its occurrence is not high. Even if some cases are reported, the overall number is very small.

The sudden emergence of the instant light made Zheng Ren find a new direction.

He thought about it. He had dissected the experimental body and had not seen the appendix. The intracavity appendix was the only possibility.

Then open it.

In front of the experimental body, the vertical incision next to the right rectus abdominis muscle, 10cm, cut into the abdomen layer by layer to find the location of the cecum.

Zheng Renxian touched it with his hand.

There was no sign of intraluminal appendix in the cecal end.

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

On the operating table outside, this operation should be avoided as much as possible. Because it damages the intestinal mucosa, it will increase the possibility of postoperative intestinal adhesion and intestinal obstruction.

But in the system operating room, Zheng Ren has no scruples in this regard.

The ileocecal part was up and touched for about 12cm. Zheng Rencai vaguely touched a foreign body.

Normally, it should be something like feces. But for Zheng Renlai, who can't find his appendix, this is the clearest hint.

After all, it is an experimental body, and the strength is a little presumptuous. Now, Zheng Ren's heart is more at bottom.

He then took the lancet and cut the cecum.

As the intestines were cut open, the elusive appendix appeared in the field of vision. It is like a small insect, lying obediently at the end of the cecum with slight edema.

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 is estimated to be the reason why there was no intestinal obstruction.

There is a little purulent coating, congestion and edema on the surface of the appendix. It is still early. It is estimated that perforation will occur in at least 2-3 days.

But how do you cut it?

Zheng Ren is a little confused.

It's not like the appendix is outside the cecum. Cut it off, ligate it, pay attention to the Appendix Artery, and then it's finished.

Now the appendix is in the cecum, and the intestine is reflexed. It is still difficult to remove it after incision.

Try it.

Zheng Ren began training to cut the appendix.

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

……

……

"Boss Zheng, would you like to have a look?" Feng Jianguo whispered.

"How long does the patient fast before operation?" Zheng Ren suddenly asked.

"Six hours." Another professor with a group whispered.

"Routine, no enema."

"Yes." The two leading professors and Director Wei were puzzled. Boss Zheng asked what to do with so many questions.

"If you can't find it, it may be the intracavity appendix. It's best to take a look with enteroscope. But there's no enema..." although Zheng Ren has determined that it's the intracavity appendix, he always has to give a reason to cut the intestines.

Director Wei moved in his heart and said, "boss Zheng, I touched it. There is no appendix in the cavity 6-8cm up and down the ileocecal part."

Experience is really rich, Zheng Ren thought to himself. But the position of the patient's appendix is very special, far from the ileocecal part, so Director Wei didn't touch it.

If there were not a systematic operating room, I would not be able to find the location of the appendix in the cavity if I could explore it recklessly.

Thinking of this, Zheng Ren asked, "Director Wei, I've looked for my intestines, haven't I?"

"Yes." Director Wei nodded.

"What about the retroperitoneum?"

"There's no hernia, not a retroperitoneal appendix." Director Wei sighed. It seems that what boss Zheng said is useless.

Zheng Ren looked at the eye operation area and said, "it's all turned over. I think it's more likely to have an appendix in the cavity. Otherwise, use an enteroscope to observe it?"

"Colonoscopy?!" Director Wei was stunned.

"Well, on the premise that the diagnosis is OK, we have looked in the abdominal cavity, but we still haven't seen the appendix. Considering the possibility of the appendix in the cavity, maybe it's position variation. It's suggested to use enteroscopy. If we can't find it, let's think of another way."

Then he looked at Director Wei and asked, "what do you think, Director Wei?"

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

The itinerant nurse was silly.

And intraoperative enema? It's a lot of trouble.

Troubles are small things. What is more troublesome than a "missing" appendix?

Patient's posture, sterile area, plus enema operation... What about the things that come out?

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

"Three days." Another professor with the group said, "the diet is liquid and the amount is small. It should be... The feces are almost discharged."

"Try colonoscopy. Don't enema first. You don't need colonoscopy to do anything. Just take a look. If there are lumps of feces, it's time to enema again." Zheng Rendao.

The itinerant head nurse breathed a sigh of relief.

"I'll have an enteroscope." Feng Jianguo said.

"Director Luo came up with me. It's estimated that it's coming soon. Let director Luo do it." Zheng Ren was going to brush his hands and said later.

Director Luo? What's he doing here?