Jin Cheng and others also followed.
It is impossible for Jincheng to find the appendix now. However, he wants to make the surgical incision as small as possible, because it requires laparotomy, and the incision is at least 10 centimeters higher, and he now has Master-class traditional appendectomy, no matter how complicated the appendix is, the wound will not exceed 5 centimeters.
This requires fighting for the right to operate, but Director Tang and Xu Yang are general surgeons, and it seems that they can't do it themselves.
"Brother, why are you so confident! What if you can't find it even if you try to find it?"
In the locker room, Zhao Xiaogang asked while changing clothes.
Jin Cheng shook his head and said: "The appendix is right there, and I have to dig three feet to find it!"
Well!
Zhao Xiaogang thought Jin Cheng had some unique secrets that could quickly find the appendix, but he didn't expect it to be so simple and crude.
Jin Cheng quickly changed into hand washing clothes, he wanted to stop them before they cut open.
Arrive at operating room No. 11.
Xie Yalun just finished reporting the situation to Director Tang.
Jin Cheng and Zhao Xiaogang walked in. Han Yue had already arrived one step ahead of them.
At this time, Director Tang was still standing in front of the reading light, looking at the CT film of the abdomen, frowning.
"Director, what's going on?" Jin Cheng came to Director Tang and started watching the movie.
Director Tang glanced at Jin Cheng and said, "Jin Cheng, you don't understand anything about the situation, how can you talk to the patient's family like that! You talk too much, and our pressure will increase a lot!"
Jin Cheng nodded and said: "If you don't say so, the patient's family will not agree at all. Don't worry, director, I am good at finding this."
Director Tang looked at Jin Cheng in confusion and said, "Then help me quickly find out where the appendix went?"
"Have they all been investigated?" Jin Cheng asked.
Director Tang nodded, "We searched the cecum, front, back, left and right, and also considered the extraperitoneal appendix, high and low appendix, basically everything that can be considered."
Jin Cheng nodded and said, "Is it possible that it's an intracavity appendix?"
A normal appendix grows outside the cecum. The so-called intraluminal appendix means that the appendix has a modified position and grows in the intestine. Compared with a normal appendix, this type of appendix is more susceptible to infection and necrosis.
Director Tang shook his head, "It's impossible. The intraluminal appendix can also be found on CT and B-ultrasound, but there is no sign that there is an appendix in the cecal lumen."
Jin Cheng held his chin in one hand and hugged the hand holding his chin in the other, and began to observe the CT carefully. After watching it for a while, he confirmed that there was no obvious signal abnormality in the lumen.
Jin Cheng did not enter the simulated operating room immediately, but relied on his own master-level experience to make judgments. Relying too much on the eyes of the sky would make him lose his ability to diagnose diseases.
Everyone is waiting for Director Tang to make a decision, but Director Tang is waiting for Jin Cheng. After all, Jin Cheng has given him too many surprises, and maybe he can continue to surprise him!
After looking at the CT images, Jin Cheng constructed a three-dimensional image of the cecum in his mind. At the junction of the ileum and cecum, on the back wall of the cecum, there is a section of intestinal tube that is slightly bulging. If you don't look carefully, it is easy to ignore.
Could it be an intramural appendix?
The more Jin Cheng thought about it, the more he felt it was very possible.
The so-called intramural appendix refers to an appendix that neither grows outside the cecum nor grows in the cecum, but grows within the intestinal wall tissue. It is very rare in clinical practice. Even in top provincial hospitals, a doctor may suffer from it in his lifetime. Can't come across one.
Jin Cheng came to the patient and took a look. She was a very young woman. No wonder the patient's family did not agree to the laparotomy.
Xu Yang was still holding the laparoscope. He looked at Jin Cheng and said, "Can't you tell?"
It's weird to see that. You are a surgeon, but you are involved in difficult general surgery. Isn't this adding chaos?
"Brother Xu, can you turn over your cecum and show it to me?" Jin Cheng said, but he still hadn't opened his eyes.
Xu Yang shook his head and said: "I also checked the rear part, but it's not there."
Jin Cheng shook his head, "I want to see the shape of the posterior wall of the cecum. I think there is something wrong with the posterior wall."
"There's a little inflammation in the back wall, but everything else is fine." Xu Yang shook his head, too lazy to do anything. You, Jin Cheng, can't possibly be better than us at diagnosing the appendix, which is a general external tube.
Director Tang came over, picked up the forceps himself, and gently opened the cecum. He saw that the posterior wall of the cecum was congested and edematous, with an obvious inflammatory reaction.
Jin Cheng can be sure that the back wall here wraps the appendix.
When I opened my third eye, I saw a swollen appendix in the intestinal wall. The capsule was still intact and there was no perforation.
"Do you see the problem?" Director Tang said solemnly.
Jin Cheng nodded and said, "I suspect this is an intramural appendix."
Um?
Everyone was surprised. In fact, except Director Tang and Xu Yang, no one else had heard of it.
Director Tang's eyes lit up, as if the clouds were clearing and the sun appeared, and he quickly said: "How can you be sure?"
Jin Cheng said solemnly: "Through CT three-dimensional reconstruction, I found that there are strips of tissue in the posterior wall of the cecum, similar to the appendix. Considering that all possibilities have been ruled out before, the only possibility is an intramural appendix!"
"Three-dimensional reconstruction? Where did you see the three-dimensional reconstruction?" Director Tang frowned and asked. Only orthopedic films have real 3D reconstructions. Where can I see the reconstruction of the intestines?
Jin Cheng pointed to his head and said, "I reconstructed it in my mind!"
this!
Everyone was surprised, but no one doubted Jin Cheng. After all, his performance during this period was so amazing that he must have extraordinary abilities.
"Are you sure it's in the inflammatory tissue on the posterior wall of the cecum?" Director Tang confirmed again.
Jin Cheng nodded: "Sure, it's here!"
Director Tang no longer had any doubts, changed the instruments, and began to prepare for incision and exploration of the intestines.
"Director Tang, don't you want to do laparotomy?" Jin Cheng asked. He was not familiar with laparoscopy.
Director Tang shook his head and said: "It's okay, as long as I can find the appendix, I can cut it out!"
Jin Cheng nodded and no longer struggled with whether he could undergo surgery. After all, minimally invasive surgery would definitely be the best, and the patient was the most important.
"Is it here?" Director Tang pointed to a location on the cecum.
"Just one centimeter more."
"Here?"
"Move back 0.5 centimeters..."
"Yes, this is it!"
Under Jin Cheng's guidance, Director Tang determined the position and began to cut the intestines.
After cutting, start to separate little by little.
Every step is careful, but every step is steady.
Jin Cheng could tell that Director Tang's skills were quite good, in line with the standards of a chief physician in a tertiary-level hospital in a prefecture-level city.
"found it!"
Xie Aaron shouted excitedly.
I was quite frightened just now, but now I finally found the target, and there was no abdominal incision. This result couldn't be better, and the family members can communicate well!
"Haha, Jincheng, you can do it! A group of us have been researching and analyzing for a long time, and you can solve the problem in just a few minutes." Director Tang said with a smile.
The difficulty of this operation is not the treatment, but finding the appendix. Now that the crisis is over, Director Tang feels relaxed and has a smile on his face.
