Chapter 32: Acute Abdomen

"Name?"

"Griss."

"No, I mean this child's name. How old is she?" Kraft quickly filled in Griss's name in the family member column, noting the patient's father.

They were sitting in an empty classroom; Lu Xiusi had been sent to fetch two blankets, as the patient lying on a hard bench would inevitably be uncomfortable. The accompanying students were held back, leaving enough space.

The paper in his hand was torn from a sheet of copying paper, placed atop the second volume of "Human Anatomy," while a nearby student, perceptive enough, handed him an inkwell. The pen tip sketched rapidly across the paper, the characters written forming a continuous string.

Although Kraft's handwriting was indeed good, his medical records were always crooked and messy; one didn't know if some mysterious force influenced this.

"Liss, her name is Liss." Griss was somewhat terrified, answering Kraft's questions quietly and quickly, as if a moment's delay would cause Kraft to abandon the case. "She is three years old this year."

A large group of black-robed figures exerted considerable pressure on him. They had already stepped back as requested, yet the bright classroom still felt filled with a gloomy, terrifying atmosphere.

"Where does it hurt?" Kraft asked while turning his head to glance at the child lying across the chair. At this age, it was truly difficult to discern the child's gender without speaking; upon careful recollection, he had indeed seen this child in the tavern sometimes, but a set of unremarkable clothes had led him to assume it was a boy.

Speaking of this topic, Griss looked as if he were about to cry, his eyes red, yet he still restrained his emotions, describing what he knew in the clearest way possible.

"Two days ago, she seemed to have eaten something, and she has had diarrhea ever since. I originally thought she would recover in a few days, but this morning her stomach hurt even more, so much that she could barely speak a few words.

Before, I took her to the church to get some holy water, and I also went to the clinic; she drank herbal soup, but it was useless."

"What herbs?" Kraft pressed. He knew about holy water; it was merely purified water that had undergone some strange rituals. He had drunk it himself as a child; as a placebo, it could at least be considered harmless.

Herbs were another matter entirely. Few doctors running clinics outside were graduates of the academy; all sorts of folk remedies and strange prescriptions ran rampant, with anything daring to be added to the medicinal soup.

This was not like the practice of Traditional Chinese Medicine with its syndrome differentiation and treatment; the medical methods of amateur doctors in Wendeng Port were less like treating humans and more akin to certain green-skinned things that grew from the ground, with the main guiding ideology being "I reckon."

"I'm sorry, I don't know..." Griss looked bewildered and helpless. "The priest said it was because I did not believe in the Lord with all my heart. Should I not have let her drink that herbal soup?"

This middle-aged man painfully grabbed his head, almost pulling out his hair. In his eyes, this was a harbinger of death; he might lose his only child.

"I didn't mean that." Kraft placed a hand on his shoulder, trying to calm him down. "It doesn't matter if you can't remember; I have other questions I need to ask you."

It had to be said that Griss belonged to the type of parents doctors liked best. Amidst the panic and fear regarding his daughter's condition, he was already quite calm, allowing Kraft to quickly obtain relatively complete information.

The patient was Griss's three-year-old daughter, Liss, who had suddenly developed fever and diarrhea symptoms two days prior, with stools as thin as water.

This was not originally anything strange; for a child of this age to get a stomach upset for no apparent reason was perfectly normal, and in most cases, parents would not pay too much attention.

As a father who paid relatively close attention to his child, Griss had even taken time specifically to pray at the church and brought back some holy water for her.

However, one day after drinking the holy water, little Liss's condition did not improve, so the worried Griss took her to a nearby clinic again, where the doctor prescribed a dose of herbal soup.

Seeing the soup's somewhat abnormal color, Griss still decided to let Liss try it; the result was that trying led to death. Early this morning, Liss's previously not-too-serious abdominal pain rapidly worsened; although little stool was passed, it was tinged with blood.

An anxious Griss took Liss to the church and the clinic, but the priest merely stated that this situation could only be met with sincere prayer, waiting for God's will. The clinic doctor was even more helpless, thinking only of absolving himself of responsibility.

As someone who had long run a tavern next to the academy, the last method Griss could think of was to seek help from acquaintances within the academy; otherwise, he could only wait to see if Liss would miraculously recover on her own.

"I need to perform an examination; is that okay?" Kraft finished writing the history of present illness and basic information on the paper. The content regarding past medical history and family history consisted of only a few brief strokes; he only knew that Liss's mother had also died of an acute illness, though Griss could not say what disease it was. However, Liss had not suffered any major illnesses since birth.

"Okay, thank you." Griss nodded hurriedly; he did not understand why this required his permission, but seeing Kraft's attitude, it seemed he intended to take the case.

"I mean a comprehensive examination, involving contact with the entire abdomen, including the groin." Kraft glanced at the group of students behind him, feeling he needed to explain first. "I think this is not suitable for too many onlookers. Gentlemen, would you mind stepping aside for now? You can use this time to review why I asked so many questions."

"Um... no problem." Griss hesitated for a moment but agreed, preparing to go out with the students. Perhaps Kraft's serious attitude had earned his trust, as he raised no questions.

"Griss, come back; I meant them. Family members stay to accompany and help soothe the child." The students quickly exited; Kraft pulled Griss to the child's side and began the examination.

Kraft lifted the hair, touching Liss's forehead; the temperature was not high. The child's face was streaked with tears; the lack of crying suggested she had cried for a long time and was now too exhausted to cry.

His heart actually already had a rough idea; this was the kind of thing most loved to be taught in diagnostics—acute abdomen, colloquially "Doctor, my stomach hurts." Even without Kraft's extraordinary memory, he could skillfully apply its contents.

A three-year-old child with diarrhea and fever for two days; it should be a gastrointestinal infection caused by some pathogen, very common in Wendeng Port where seafood is everywhere.

But today's situation was eighty percent not the fault of worsening infection. Sudden reduction in bowel movements, accompanied by blood, suggested an obstruction somewhere.

Kraft touched the seemingly normal abdominal wall; pressing down, he felt no obvious tightness or stiffness.

This made him breathe a slight sigh of relief; it seemed it had not yet become severe enough for exudate to irritate the peritoneum; perhaps the matter was not serious.

Following a fixed direction, he quickly found evidence corroborating his viewpoint: a mass located in the lower right abdomen, feeling somewhat like a sausage.

The situation was manageable; Kraft's worried heart finally settled. It should be intussusception; based on this location, one could boldly guess it was ileocecal intussusception.

At the junction of the small and large intestines, a segment of the ileum in the ileocecal region had telescoped into the large intestine; one layer of wall became several, causing an immediate blockage. For children with easily disordered intestinal function, this was not uncommon and was one of the acute abdomens most frequently handled in pediatric surgery.

This unlucky child probably had viral diarrhea, which is itself a risk factor for intussusception, and then drank some strange herbal soup, naturally resulting in intussusception.

This diagnostic process went quite smoothly, giving Kraft a feeling of handling a teacher's questions during a case discussion class; after finding all the evidence, he confidently gave the answer.

Theoretically, the next step would be imaging examination for confirmation, but unfortunately, there was no ultrasound here, nor could an upright abdominal X-ray be performed; one could not dream of one hundred percent confirmation.

He re-covered the child with clothes, picked up paper and pen, and created a "Preliminary Diagnosis" section at the bottom of the page. Using Norse, he combined the phrases "intestine" and "telescoped," leaving a line of space below.

When he had free time later, he would have to add an explanation line below; ever since becoming a lecturer, he had to leave blanks everywhere for term explanations, almost becoming a professional habit.

Looking up to explain to Griss: "You can understand it as a segment of her intestine telescoping into another segment, then getting blocked like that. Do you remember when she started hurting?"

"Probably before the clock tower struck twice; I took her to the church once, but I don't remember the exact time."

That was roughly between one and a half to two hours; a great fortune amidst misfortune. Discovered in time, even after a trip to the church, this timeframe had not yet reached the point of intestinal necrosis; a non-surgical solution could resolve it.

So, what was the non-surgical solution again?

"That's not right..." Kraft murmured, his heart immediately rising again, just like solving a high-level math problem smoothly until the final step, only to get stuck, finding nothing wrong but the calculation volume being insufficient to reach the answer.

"What's not right?" Griss grew nervous too; Kraft had just explained the cause of the illness to him, yet now things seemed to have become complicated again. The most feared thing at such a moment was for a doctor to wear a "smile gradually disappearing" expression.

Kraft did not answer him; a serious question stood before him, blocking the final path forward.

For the current situation, the standard answer he knew was air enema, which could easily resolve most early-stage acute intussusception cases like Liss's.

But this required corresponding equipment; he was not studying machinery manufacturing and had no idea how to control air pressure to push the intestine back into place while ensuring no perforation occurred.

Even if he knew how to manufacture it, could he simply conjure a machine out of thin air? Even taking ten thousand steps back, even if a church god manifested on the spot and conjured a machine for him, how could one confirm successful reduction without imaging examinations like ultrasound or X-rays?

Since the air enema solution was unworkable, only the traditional method remained—Kraft had to perform surgery, letting little Liss endure a cut, using a traumatic but more direct and effective method to push the intestine back.

But if air enema was impossible, could surgery be performed under these conditions? Performing surgery without anesthesia and without sterility was worse than praying for God to send an angel to deliver an air enema machine.