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

Appendectomy is the basis of surgery.

Zheng Ren's foundation was laid very firmly, enough to support a towering building.

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

Standing in front of the operating table, Zheng Ren thought for a while and carefully selected the right rectus abdominal incision, with a direct large incision, 10m.

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

Because he was worried that he would indulge too much, he would make a big mistake outside one day, so Zheng Ren habitually took care of the routine surgery in the system space.

Ten minutes later, Zheng Ren sighed.

He knew what happened to Director Wei, and he didn't have an appendix!

After stroking my intestines, I didn’t find where the appendix was!

Zheng Renning was willing to encounter gangrenocortic appendicitis of Fan Tianshui or Wu Hui's appendicitis that was removed at one time, and he was unwilling to encounter this appendicitis.

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

Yes, but where is the appendix?!

Let’s dissect it, you can only use the last killer weapon.

Zheng Ren did not hesitate and looked around, confirming that there was no assistant, no anesthesiologist, and the environment was also a system operating room.

And what is in front of me is the experiment subject, not the patient.

The knife was dropped by hand and the experiment began to be dissected.

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

On the operating table... On the anatomy table, the intestines were completely turned out, and the appendix was not seen under direct sight. The peritoneum was very complete, and there was no peritoneal cleft, and the appendix hernia could reach the back of the peritoneum.

There are no inguinal hernia, etc.

A simple and standard anatomical structure means there is no appendix.

The operation was declared a failure.

Appendicitis, the operation failed!

Zheng Ren was a little depressed.

He recalled what Director Luo said just now, "Don't look at the simple gastroenteroscope, he will do his best every time he does it."

Even so, mistakes cannot be avoided.

My general surgery level is already a master's level, and there is a systematic operating room that allows me to directly perform anatomy.

Even so, the appendix cannot be found.

He sighed, calmed down his irritability, and selected 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 surgery, but recalled quietly.

Various literature reports and case analysis.

A case like a revolving lantern flashed in my mind, and Zheng Ren suddenly remembered a possible intracological appendix.

The intraluminal appendix refers to the appendix that does not grow outside, but into the cecum.

The cecum is the starting section of the large intestine and the shortest section in the large intestine. It is about 6 to 8m long and is located in the lower right part of the abdominal cavity.

There is an ileococcus valve at the junction with the ileum, and the cecum is the lower part, with a fora connected to the appendix, and then it is continued to connect to the ascending colon.

This is the starting part of the large intestine, which is in the shape of a cystic bag, located in the right iliac fossa, and is connected to the ileum. The mucosa at the entrance of the ileum leads to the cecum protrudes into the intestinal cavity, forming two upper and lower lip-shaped ileococal flaps, which prevent the contents of the large intestine from flowing back into the small intestine.

In many places, especially on the side of Xiangjiang, appendicitis is called appendicitis because of this anatomical structure.

The appendix in the cavity is that the appendix does not wander outside the cecum, but grows abnormally inside the cecum.

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

Moreover, the chance of it appearing is not high, and even if some cases are reported, the overall number is small.

The sudden appearance of inspiration made Zheng Ren find a new direction.

He thought about it and found that he had done an anatomy of the experimental subject and had not seen the appendix yet. The appendix in the cavity was the only possibility.

Then open it and take a look.

Before coming to the experiment, there was still a vertical incision next to the right rectus abdomen muscle, 10m, and incision layer by layer to find the location of the cecum.

Zheng Ren touched it with his hands first.

There is no sign of the presence of an intraluminal appendix in the cecum tract.

But Zheng Ren did not give up and began to continue touching his intestines.

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

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

The ileo-blind part was upwards and touched it for about 12m before Zheng Ren touched a foreign object.

Normally, this should be objects like feces. But for Zheng Ren, who cannot find the appendix, this is the clearest hint.

After pinching it, Zheng Ren felt more confident.

He then took the lancet and cut the cecum open.

As the intestine is cut open, the appendix that cannot be found everywhere appears in the field of vision. It is like a small insect, lying obediently at the end of the cecum with a slight edema.

Now Zheng Ren had a place to go and fell into the ground.

He carefully observed the appendix. In terms of "size", the patient's appendix was relatively small, which probably did not cause intestinal obstruction.

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

But how to cut it?

Zheng Ren was a little confused.

It’s not like the appendix is ​​outside the cecum, which is cut off, ligated, and pay attention to the appendicular artery, and then it’s alive.

Now that the appendix is ​​in the cecum, the intestine is reversed, and it is still difficult to remove after incision.

Try it.

Zheng Ren began to train to cut the appendix.

It seemed that he had returned to the time when the system space was unstable, Zheng Ren returned to the origin and began to study appendectomy again.

...

...

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

"How long does the patient have to fast water before surgery?" Zheng Ren suddenly asked.

"6 hours." Another professor in the group said in a low voice.

"Routine, no enema."

"Yes." Both professors and Director Wei were puzzled. Boss Zheng asked so much about what he was doing.

"If you can't find it, it may be the intraluminal appendix. It's best to take a look with a colonoscopy. But there is no enema..." Although Zheng Ren has confirmed that it is the intraluminal appendix, he always has to give people a reason to cut the intestine.

Director Wei's heart moved and said, "Boss Zheng, I've touched it. There is no appendix in the cavity 6-8m up and down in the ileoencephaloss."

The experience is really rich, Zheng Ren thought to himself. However, the patient's appendix position is extremely special and is far from the ileocecal part, so Director Wei did not touch it.

If it weren't for the systematic operating room, I could have unscrupulously investigated, and I probably wouldn't have found the part of the appendix in this cavity.

Thinking of this, Zheng Ren asked: "Director Wei, I've found all my intestines, right?"

"Yes." Director Wei nodded.

"Where is the posterior peritoneum?"

"There is no hernia, not the retroperitoneal appendix." Director Wei sighed, as if what Boss Zheng said was useless.

Zheng Ren looked at the surgery area and said, "I have turned it over. I am considering that there is a high possibility of the appendix in the cavity. Otherwise, I can observe it with a colonoscopy?"

"Collection Scope?" Director Wei was stunned for a moment.

"Well, under the premise that the diagnosis is fine, I have searched all the abdominal cavity, but I still haven't seen the appendix. The possibility of considering the appendix in the cavity is relatively high, and maybe it may be due to the location variation. It is recommended to use a colonoscopy to see it. If it still cannot be found, we will think of other solutions."

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

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

The circuit nurse was stunned.

Also need an intraoperative enema? How troublesome this is.

Trouble is a trivial matter, what else is more troublesome than a "missed" appendix?

What should I do if the patient's position, sterile area, and enema operation are added...?

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

"Three days." Another professor in the group said, "The diet is liquid food, the amount is small. It should...there should be almost the same sorting."

"Try colonoscopy, don't have enemas for now. Don't do anything with colonoscopy. Just take a look. If there are blocks of feces, it's time to even enemas." Zheng Ren said.

The head nurse breathed a sigh of relief.

"I'll go for a colonoscopy." Feng Jianguodao.

"Director Luo and I came up together, probably soon. Let Director Luo do it." Zheng Ren was about to go and brush his hands and said back.
Chapter completed!