I really don't want to be a doctor

Chapter 10 Ectopic appendix
Appendectomy only requires an assistant for the retractor to expose the field of view.

But this operation is a bit of an exception.

Li Xiaojun assisted first, and Yang Le assisted second.

When the two retractors were inserted into the abdominal cavity together, the field of vision was completely exposed.

"Where's the appendix!!"

Seeing the situation in the abdominal cavity, Li Xiaojun's face changed and he exclaimed.

Max point, there is no appendix at all.

Yang Le is just a real intern. The situation in the abdominal cavity is complicated. He can't understand all kinds of intestines and omentum, so he didn't respond at all.

It's just a serious face, scanning the situation in the abdominal cavity with doubtful eyes.

Yu Wenxing's face turned pale.

Appendectomy is the most common operation in general surgery. This operation is not difficult, but the difficulty is how to find the appendix.

And this step makes countless big bosses dare not say explicitly that they can perform all appendectomies.

Even those well-known general surgeons at home and abroad have more or less encountered situations where the appendix cannot be found.

Director Deng came over, looked at the situation in the abdominal cavity, and showed an indistinct smile.

On the forehead exposed under the mask, the wrinkles seem to be much less.

Yu Wenxing looked at the situation in the abdominal cavity, but didn't take the next step.

"How about I come?"

Li Xiaojun asked softly.

Yu Wenxing shook his head, continued to think for a moment, and began to search step by step.

Opening the omentum and pushing open the intestinal tract, Yu Wenxing searched inch by inch, but after turning over all the intestinal tracts that could be turned in his field of vision, Yu Wenxing could not find the shadow of the appendix.

"Heterotopic appendix!"

Yu Wenxing let out a heavy breath,

"Change it to hemp."

The anesthetist glanced at Director Deng, saw him nodding, picked up the video laryngoscope, placed the endotracheal tube, and began to push the medicine.

The patient's breathing was quickly interrupted and mechanically controlled breathing began.

"Take some more muscle relaxants."

Yu Wenxing continued talking.

He also knew that the patient should have an ectopic appendix, and that the operation should take place continuously, and the muscle relaxant could facilitate the exposure of the field of vision.

"Chun A 0.2, static push." ​​The anesthesiologist took out a syringe.

Cisatracurium is a common muscle relaxant with good effect, low price, fast onset time and long maintenance time.

The medicine in the syringe was pushed halfway, and the anesthesiologist stopped and signaled Yu Wenxing to continue.

Without any hesitation, Yu Wenxing extended the upper and lower incisions by 1cm, and continued to search.

In fact, there are traces to follow when looking for the appendix.

The cecum is the beginning of the large intestine. There are three colonic bands on its surface. Below the connection of these three colonic bands is the appendix.

But for a section of appendix, it is obviously impossible to take out the entire large intestine and search for it carefully.

The incision doesn't have this condition at all.

If you really want to do this, you have to make an abdominal exploratory incision in the middle of the abdomen, usually more than 20cm long.

Find in tight spaces.

This is the time to test a person's skills and abilities.

"Ms. Li, didn't you just say that the root of the appendix is ​​at Mai's point?"

Seeing that Yu Wenxing had searched for a long time but couldn't find it, Yang Le asked.

Li Xiaojun pondered for a while, "The intestinal tract in the abdominal cavity is not static, but is always moving. The result of CT is the situation at that time, but now it seems that the appendix may have disappeared."

"Therefore, there is a saying in general surgery that the operation of general surgery is always the same, and that is to open the stomach."

Yu Wenxing was still in the mood to joke.

Li Xiaojun stared at Yu Wenxing speechlessly, looked at Deng Liming who was standing beside him without saying a word, and reminded: "Yu Wenxing, you need to do the surgery first."

"Good." Yu Wenxing moved the hook, "The appendix should be on top."

Yu Wenxing continued to search.

"Colon band!"

Soon, a section of omentum was held in Yu Wenxing's hand.

Yu Wenxing extended the incision upwards by 1 cm, and the colon was slowly dissected apart, and it turned in reverse.

"No wonder, the colon band, which should obviously go down, actually goes up."

Li Xiaojun felt a sudden realization.

"It should be the appendix under the liver."

Director Deng also spoke.

The corner of Yu Wenxing's mouth pulled out an arc, and his right hand slowly rubbed in his abdomen.

A few minutes later, Yu Wenxing's right hand suddenly stopped moving.

"Hemostatic forceps!"

The hemostat was passed to Yu Wenxing's hand, Yu Wenxing held the hemostat with his left hand, and penetrated into the abdominal cavity.

"Crack!"

"Crack!"

After two clamping sounds, Yu Wenxing's hands withdrew from the abdominal cavity.

"Caught?" Li Xiaojun asked.

"You come to touch it?" Yu Wenxing asked.

Li Xiaojun nodded, it's not that he doesn't trust Yu Wenxing, after all, it's the appendix clamped without vision, it's okay if it's the appendix, if it's not the appendix, it will be troublesome if you cut other organs.

Li Xiaojun changed positions, and after feeling it for a while, he looked at Deng Liming.

"It should be the appendix."

Deng Liming nodded, and the operation continued.

Now that the appendix is ​​clamped, the follow-up operation is much simpler. After the incision is enlarged by 1cm again, the appendix is ​​pulled out.

The appendix has long been decayed, and it seems that it will be broken if it is pulled lightly.

Carefully handle the mesentery surrounding the appendix.

Carefully clamp the blood vessel closed.

A purse-string suture was carefully performed on the edematous intestinal wall.

A total of five hemostats were used to remove a section of the appendix that was about to completely burst out of the abdominal cavity.

Li Xiaojun breathed a sigh of relief.

The rest is normal operation.

Ornidazole rinse.

Wet gauze treatment.

Make sure there are no bleeding spots.

Leave the drainage tube in place.

Close the stomach at last.

Yu Wenxing looked up.

78 minutes.

After the abdomen was shut down, the patient walked out of the operating room and went to the anesthesia recovery room. Deng Liming was still looking at his phone.

Li Xiaojun walked over carefully, and glanced at the phone screen.

A dark green.

"Director Deng, is there another surgery?"

Li Xiaojun asked.

"Let's sum it up."

Deng Liming hastily turned off the screen and coughed lightly.

"The operation was difficult, the appendix under the liver, but everything went well."

Deng Liming nodded, "Tell me the reason why it went so smoothly."

Li Xiaojun thought for a moment.

"First, this patient is relatively thin, with less abdominal fat, which is convenient for exposing the field of vision."

"Second, the patient is young, has good physical ability, and has no intestinal adhesions."

"Third, although the patient has an ectopic appendix, Yu Wenxing has consciously chosen it since the incision."

Deng Liming took a sip of tea, then looked at Yang Le again.

Yang Le was still bewildered.

"seems very amazing."

Deng Liming almost couldn't hold back his laughter again.

Finally, Deng Liming looked at Yu Wenxing.

"Everything is under control."

As Yu Wenxing said, his eyes involuntarily showed a gleam of confidence.

"Why did you use the right lower abdomen to explore the incision?" Director Deng asked again.

Li Xiaojun also showed a puzzled expression.

Yup!

The reason why the operation was so smooth is directly related to the initial incision. If it was the McBurney incision in the right lower abdomen, how could this operation go down without knowing?
A smaller wound means a smaller field of view.

Yu Wenxing was silent for a while.

"During the physical examination, the tenderness was slightly upward. I was afraid of an accident."

Deng Liming didn't speak, looked at Yu Wenxing, and took a sip of tea.

　The new book is on the road, please take care of the officials.Thank you!
　　
　
(End of this chapter)