Chapter 1501： Endoluminal appendix

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

Appendectomy is the basis for surgery.

Zheng Ren’s foundation is extremely strong enough to prop up the tall buildings.

But even then, Zheng Ren can't guarantee that this appendectomy will be able to get it down.

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

Open the peritoneum, and Zheng Ren began to lick the intestines.

Because he was worried that he was too indulgent, so that he would make a big mistake outside the day, so Zheng Ren habitually followed the routine surgery in the system space.

Ten minutes later, Zheng Ren sighed.

He knows what happened to Director Wei, no appendix!

I licked the intestines and found nowhere in the tail!

Zheng Renning is willing to encounter Fan Tianshui’s kind of gangrenous appendicitis, or Wu Hui’s kind of appendicitis that has not been cut off and is not willing to touch this appendicitis.

He carefully looked through the system panel, the diagnosis is very clear, it is indeed acute simple appendicitis.

That's right, but where is the iris? !

Anatomy, you can only use the last big killer.

Zheng Ren did not hesitate, looked around and determined that there were no assistants, no anesthesiologists, and the environment was also a system operating room.

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

The hand fell off and began to dissect the experimental body.

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

On the operating table... on the dissection table, the intestines were completely turned out, and the position of the appendix was not seen under direct vision. The peritoneum is very intact, there is no peritoneal rupture, and the appendix is ​​likely to be retroperitoneal.

There are also no cases of inguinal hernia.

The simple and standard anatomy is the absence of a tail.

The surgery failed.

Appendicitis, the surgery actually failed!

Zheng Ren is a bit depressed.

He recalled the words that Director Luo had just said. Don't look at the simple gastrointestinal mirror. Every time you do it, you will go all out.

Even so, mistakes cannot be avoided.

His level of general surgery has been master level, plus a system operating room allows you to open the anatomy directly.

Even so, you can't find the tail.

He sighed and calmed his violent mood and selected another operation.

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

Zheng Ren did not worry about surgery, but quietly recalled.

Various literature reports, various case studies.

The case of the lantern was flashing in my mind, and Zheng Ren suddenly remembered a possibility - the appendix in the cavity.

In the cavity, the appendix means that the appendix does not grow to the outside, but grows into the cecum.

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

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

Here is the beginning of the large intestine, in the shape of a sac, located in the right axilla, and connected to the ileum. The ileum leads to the mucosa at the entrance of the cecum and protrudes into the intestinal lumen, forming two 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 the Xiangjiang side, tube appendicitis is called appendicitis, because of this anatomical relationship.

In the endoluminal appendix, the appendix is ​​not free outside the cecum, but abnormally grows inside the cecum.

This appendix generally causes the cecum to narrow and intestinal obstruction.

And its chances of emergence are not high, even in some cases, the overall number is small.

The moment of the aura is shining, so that Zheng Ren has found a new direction.

He thought about it, he had dissected the experimental body, and he had not seen the appendix. The appendix in the cavity was the only possibility.

Then open it and have a look.

Before coming to the experimental body, it is still the vertical incision next to the right rectus abdominis, 10cm, cut into the abdomen layer by layer, find the location of the cecum.

Zheng Ren first touched his hand.

There are no signs of intraluminal appendix in the cecal end of the intestine.

However, Zheng Ren did not give up and began to continue to touch the intestines.

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

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

The ileocecal department was up, and it touched about 12cm, and Zheng Rencai touched a foreign object.

If it is normal, it should be an object such as feces. But for Zheng Ren, who can't find Shanwei, this is the most clear hint.

After pinching it, Zheng Ren’s heart is more bottomless.

He then picked up the lancet and cut the cecum.

As the intestines are cut open, the appendix that can't be found appears in the field of vision. It is like a small bug, lying on the cecum and slightly edema.

This time, Zheng Ren’s heart has gone to the ground and fell to the ground.

He carefully observed the appendix. In terms of "head", the patient's appendix is ​​relatively small, which is estimated to be the cause of intestinal obstruction.

The surface of the appendix is ​​a little bit of pus, congestion, edema, and it is still early. It is estimated that at least 2-3 days will appear.

But how do you cut it?

Zheng Ren is somewhat confused.

It is not like the appendix is ​​outside the cecum, cut off, ligated, pay attention to the appendix artery, and then it will be alive.

Now that the appendix is ​​inside the cecum, there is a reflex in the intestine. It is still difficult to cut after cutting.

Give it a try.

Zheng Ren began training to cut the tail.

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.

......

......

"Zheng boss, can you take a look?" Feng Jianguo whispered.

“How long does it take for patients to fast before drinking?” Zheng Ren suddenly asked.

"6 hours." Another group professor said whispered.

"Regular, no enema."

"Yeah." The two professors and director Wei are somewhat puzzled. Zheng boss asked so much.

"If you can't find it, it may be the end of the cavity, it is best to take a look at the colonoscopy. But there is no enema..." Although Zheng Ren has determined that it is an intracavitary appendix, but to cut the intestine, always give One reason.

Director Wei made a move and said: "Zheng boss, I have touched it. There is no intracavitary appendix in the ileocecal 6-8cm."

The experience is really rich, Zheng Ren thought. Only the position of the appendix of this patient is extremely special, far away from the ileocecal department, so Director Wei did not touch it.

If there is a system operating room, you can explore it unscrupulously, and it is estimated that there is no place in the cavity.

Thinking of this, Zheng Ren asked: "Director Wei, the intestines have been found."

"Yeah." Director Wei nodded.

"What about the posterior peritoneum?"

"There is no mouthwash, not the retroperitoneal appendix." Director Wei sighed, and it seems that Zheng Boss said that there is no use of eggs.

Zheng Ren looked at the eye surgery area Road: "It has been turned over, I think it is still possible to have a tail in the cavity. Or, look at it with a colonoscopy?"

"Enteroscopy?!" Director Wei stunned.

"Well, the diagnosis is no problem, the abdominal cavity has been found, or did not see the appendix. Considering the possibility of intracavitary appendix is ​​relatively large, perhaps the positional variation is also possible. It is recommended to look at the colonoscopy, if still Can't find it, let's think of another way."

After he finished, he looked at Director Wei and asked: "Look, Director Wei?"

"Prepare the enema during the operation!" Director Wei recognized Zheng Ren's statement. He was a little excited and said directly: "Road?"

The visiting nurse was stupid.

Still have an intraoperative enema? This is much trouble.

Trouble is a trivial matter. What else is more troublesome than the "missing" appendix?

What should I do with the patient's position, aseptic area, and enema operation?

“Wait a minute, Director Wei.” Zheng Rendao: “How many days did the patient have a pain before surgery?”

“Three days.” Another professor from the group said, “The diet is a liquid food, and the amount is small. It should be... the difference is almost the same.”

"Try colonoscopy, first without enema. Do not use colonoscopy to do anything, just take a look. If there is a piece of feces, re-enema is also available." Zheng Rendao.

The visiting nurse gave a sigh of relief.

"I am going to do colonoscopy." Feng Jianguo said.

"Director Luo and I came together, it is estimated that it is coming soon, let Director Luo do it." Zheng Ren is ready to brush his hand and turn back.

Director Luo? What is he doing?

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