On the night of appendicitis in Sea City, Zheng Ren had received sufficient appendectomy training in the System.
Appendectomy was the foundation of surgery.
Zheng Ren's foundation was extremely solid, enough to support a tall building.
Even so, he could not guarantee that he would be able to complete the appendectomy.
Standing in front of the operating table, Zheng Ren thought for a moment and cautiously chose a 10-centimeter incision next to the right rectus abdominis muscle.
He opened the peritoneum and began to stroke the intestines.
As he was worried that he would overindulge himself and commit a grave mistake one day, he habitually performed routine surgeries in the System.
Ten minutes later, he let out a sigh.
He knew what had happened to Chief Wei. There was no appendix!
He ran through the intestines, but he couldn't find the appendix at all!
Zheng Ren would rather encounter gangrenous appendicitis like Fan Tianshui's or Wu Hui's appendicitis that could not be removed on the first try than this kind of appendicitis.
He carefully looked at the System panel again, and the diagnosis was clear. It was indeed acute simple appendicitis.
Yes, but where was the appendix?!
It was time to dissect it. He could only use his final trump card.
Without hesitation, Zheng Ren looked around and confirmed that there were no assistants or anesthesiologists. The environment was also the System's operating theater.
In front of him was a test subject, not a patient.
He raised his hand and began to dissect the experiment subject.
Fifteen minutes later, he felt like he was going crazy.
The operating table … On the dissection table, the intestines had been completely turned out, and the position of the appendix could not be seen even under direct observation. The peritoneum was intact and there was no peritoneal rupture. It was possible that the appendix herniated behind the peritoneum.
There was also no inguinal hernia.
It was a simple and standard anatomical structure, but there was no f * cking appendix.
The operation was declared a failure.
The surgery for appendicitis had failed!
Zheng Ren was a little depressed.
He recalled what Chief Luo had just said. Gastroscopy might be simple, but he had to go all out every time he did it.
Even so, mistakes could not be avoided.
His general surgery skills were already at the Legend-level. In addition, he had the System's operating theater, so he could directly dissect.
Even so, the appendix could not be found.
He sighed, calmed his irritable emotions, and selected another surgery.
The dissected Experimental disappeared, and another Experimental appeared in front of him.
Zheng Ren was not in a hurry to perform another surgery. Instead, he quietly recalled his memories.
All kinds of literature reports, all kinds of case analyses.
As the cases flashed through his mind, he suddenly thought of a possibility — an endovascular appendix.
An intraperitoneal appendix referred to an appendix that did not grow outside, but grew inside the cecum.
The cecum was the beginning of the large intestine. It was also the shortest section of the large intestine. It was about 6 to 8 cm long and was located in the lower right part of the abdomen.
There was an ileocecal valve at the junction with the ileum, and below it was the cecum, which was connected to the appendix through a hole and connected to the ascending colon.
This was the beginning of the large intestine. It was in the shape of a pouch and was located in the right iliac fossa, connecting with the ileum. The mucosa at the entrance of the ileum to the cecum protrudes into the intestinal lumen, forming two upper and lower lip-shaped ileocecal valves, which prevent the contents of the large intestine from flowing backward into the small intestine.
In many places, especially in Hong Kong, appendicitis was called appendicitis because of this anatomical structure.
An intraperitoneal appendix refers to an abnormal growth of the appendix within the cecum.
This kind of appendix would usually cause the cecum to narrow and cause intestinal obstruction.
Moreover, the probability of it appearing was not high. Even if there were some cases reported, the overall number was very small.
The moment of inspiration gave Zheng Ren a new direction.
He thought about it. He had already dissected the simulation mannequin but had not seen the appendix. An intraperitoneal appendix was the only possibility.
He would open it and take a look.
He came to the front of the simulation mannequin and made a vertical 10cm incision next to the right rectus abdominis. He cut into the abdomen layer by layer and found the location of the cecum.
Zheng Ren first touched it with his hand.
There was no sign of an intraperitoneal appendix in the intestine at the end of the cecum.
However, Zheng Ren did not give up and continued to touch the intestine.
On the operating table outside, this kind of operation should be avoided as much as possible. This was because damage to the intestinal mucosa would increase the possibility of postoperative intestinal adhesion and intestinal obstruction.
However, in the operating theater of the System, Zheng Ren did not have such scruples.
Zheng Ren touched the ileocecum for about 12 cm before he touched a foreign object.
Normally, this should be an object like feces. However, for Zheng Ren, who could not find the appendix, this was the clearest hint.
After pinching it, Zheng Ren felt more confident.
Then, he picked up the lancet and cut open the cecum.
As the intestine was cut open, the appendix that could not be found appeared in his field of vision. It was like a small worm, lying obediently at the end of the cecum, slightly edematous.
With that, Zheng Ren's heart was finally at ease.
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 were some abscesses on the surface of the appendix. It was hyperemia and edema. It was still early. It was estimated that it would take at least two to three days for perforation.
However, how should he cut it?
Zheng Ren was a little confused.
It was not like the appendix was outside the cecum. It was cut, ligated, and paid attention to the appendicular artery. After that, it was done.
Now that the appendix was in the cecum and the intestine was reversed, it was still difficult to remove after the incision.
'I'll give it a try.'
Zheng Ren began to practice resection of the appendix.
It was as if 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 did the patient fast for before surgery?" Zheng Ren suddenly asked.
"Six hours," another professor said in a low voice.
"Routine. There was no enema, right?"
"Yes." The two professors and Chief Wei were a little puzzled. Why did Boss Zheng ask so many questions?
"If you can't find it, it might be an endoscopic appendix. It's best to take a look with a colonoscope. But there is no enema … "Although Zheng Ren had confirmed that it was an endoscopic appendix, he had to give a reason to cut open the intestine.
Chief Wei's heart skipped a beat. "Boss Zheng, I've touched it. There is no endoscopic appendix six to eight centimeters above and below the ileocecum. "
'He's really experienced,' Zheng Ren thought to himself. However, the position of this patient's appendix was very special. It was very far from the ileocecum, so Chief Wei did not touch it.
If it were not for the System's operating theater, he would not have been able to find the position of the appendix in the lumen if he could explore it without any scruples.
Thinking of this, Zheng Ren asked, "Chief Wei, you've searched the intestines, right?"
"Yes." Chief Wei nodded.
"What about the retroperitoneum?"
"There is no hernia. It's not a retroperitoneal appendix." Chief Wei sighed. It seemed that what Boss Zheng said was useless.
Zheng Ren glanced at the surgical area and said, "I've already looked through it. I think the possibility of an endoscopic appendix is higher. Why don't we use a colonoscope to take a look? "
"Colonoscope?!" Chief Wei was stunned.
"Yes, under the premise that there is no problem with the diagnosis, we've searched the abdominal cavity, but we still can't see the appendix. Considering that the possibility of an endoscopic appendix is higher, maybe it's a variation in position. I suggest using a colonoscope. If we still can't find it, we'll think of other ways. "
After saying that, he glanced at Chief Wei and asked, "What do you think, Chief Wei?"
"Prepare for an intraoperative enema!" Chief Wei agreed with Zheng Ren. He was a little excited and said directly, "Circuit?"
The circulating nurse was dumbfounded.
An intraoperative enema? How troublesome would that be?
Trouble was a small matter. What was more troublesome than a 'missing' appendix?
The patient's position, sterile area, and the operation of an enema … What about the things that came out?
"Wait a moment, Chief Wei," Zheng Ren said. "How many days did the patient have before the operation?"
"Three days," another professor said. "The diet is liquid food, and the amount is small. It should be … about time to distinguish it. "
"Try a colonoscope. No enema first. There's no need to do anything with a colonoscope. Just take a look. If there are lumps of feces, there's still time for an enema, "Zheng Ren said.
The circulating nurse let out a long breath.
"I'll go do the colonoscope," Feng Jianguo said.
"Chief Luo came up with me. He should be here soon. Let Chief Luo do it," Zheng Ren said as he prepared to wash his hands.
Chief Luo? What was he doing here?
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