Chapter 1548: 1501 Intraluminal Appendix (Sect Master's Crickets Chirping – Extra Update)

Hai Cheng, on the night of appendicitis, Zheng Ren in the System Space had already received sufficient training in appendectomy.

Appendectomy is the foundation, the foundation of surgical operations.

Zheng Ren's foundation is extremely solid, enough to support a skyscraper of ten thousand zhang.

But even so, Zheng Ren dared not guarantee that he could definitely handle this appendectomy surgery before him.

Standing before the operating table, Zheng Ren thought and cautiously chose a right-sided rectus abdominis parallel incision, a large incision, 10 cm.

Opening the peritoneum, Zheng Ren likewise began to feel the intestines.

Because he worried that indulging too much might one day cause a major mistake outside, Zheng Ren habitually also followed standard procedures cautiously in the System Space.

Ten minutes later, Zheng Ren sighed.

He knew what situation Director Wei had encountered—no appendix!

After feeling through the intestines once, he simply could not find where the appendix was.

Zheng Ren would rather encounter Fan Tian Shui's gangrenous appendicitis, or Wu Hui's appendicitis where the appendix wasn't removed in one excision, than deal with this kind of appendicitis.

He again carefully examined the System Panel; the diagnosis was clear—it was indeed acute simple appendicitis.

No mistake, but where is the appendix?!

Let's dissect; we can only bring out the ultimate killer.

Zheng Ren hesitated not, glanced around, confirmed there was no assistant, no anesthesiologist, and the environment was also the System Operating Room.

But what lay before him was an experimental subject, not a patient.

Hand raised, blade fell—he began to dissect the experimental subject.

Fifteen minutes later, Zheng Ren felt he was going crazy.

On the operating table… the dissection table, the intestines were completely turned out; even with direct view, the appendix's position was not seen. The peritoneum was intact, no peritoneal rupture, the possibility of the appendix herniating behind the peritoneum.

There was also no inguinal hernia, etc.

The simple and standard anatomical structure simply—damn it—had no appendix present.

The surgery was declared a failure.

Appendicitis, and the surgery actually failed!

Zheng Ren felt somewhat disheartened.

He recalled Director Luo's earlier words: "Don't look down on the colonoscope just because it's simple; every time you do it, give it your all."

Even so, mistakes still cannot be avoided.

His own general surgery skill had already reached master level, and with the System Operating Room allowing him to directly perform dissections,

Even if he had cheats turned on, he might still not find the appendix.

He sighed, calmed his irritable emotions, and selected another surgery.

The dissected experimental subject disappeared, and another experimental subject appeared before his eyes.

Zheng Ren did not rush to perform another surgery, but quietly recalled.

Various literature reports, various case analyses.

Cases flashed like a revolving lantern in his mind; Zheng Ren suddenly thought of a possibility—intraluminal appendix.

Intraluminal appendix means the appendix did not grow outward but grew inside the cecum.

The cecum is the starting segment of the large intestine, also its shortest segment, about 6–8 cm long, located in the lower right abdomen.

At the junction with the ileum there is the ileocecal valve; below is the cecum, with an orifice connecting to the appendix, which then continues downward as the ascending colon.

This is the beginning of the large intestine, pouch-shaped, situated in the right iliac fossa, connecting with the ileum. The ileum's mucosa protrudes into the intestinal lumen at the cecal entrance, forming upper and lower lip-shaped ileocecal valves, which prevent colonic contents from refluxing into the small intestine.

In many places, especially those centered on Xianggang, appendicitis is called cecal inflammation precisely because of this anatomical relationship.

Intraluminal appendix means the appendix is not free-floating outside the cecum but abnormally grows inside it.

Such an appendix usually causes the cecum to narrow, leading to intestinal obstruction.

Moreover, its occurrence rate is not high; even with some case reports, the total number remains small.

A flash of inspiration struck, giving Zheng Ren a new direction.

He thought it over; he had already dissected the experimental subject and still hadn't seen the appendix, so intraluminal appendix was the only possibility.

Then let's open it up and have a look.

Arriving before the experimental subject, it was still the previous right rectus abdominis parallel vertical incision, 10 cm, cutting layer by layer into the abdomen to locate the cecum's position.

Zheng Ren first felt with his hand.

Inside the cecal intestinal lumen there was no sign of an intraluminal appendix.

But Zheng Ren did not give up; he began to feel upward along the intestine.

On an ordinary operating table outside, this maneuver should be avoided as much as possible, because damaging the intestinal mucosa increases the chance of postoperative intestinal adhesions and obstruction.

But in the System Operating Room, Zheng Ren had no such concerns.

Moving upward from the ileocecal region, he felt about 12 cm before vaguely contacting a foreign body.

He gave it a firm pinch, not caring whether postoperative intestinal obstruction would occur—after all, it was an experimental subject, and he used somewhat reckless force. Now Zheng Ren felt more confident.

He then picked up the Willow Leaf Blade and cut open this segment of the cecum.

As the intestinal tract was cut open, the appendix that had been nowhere to be found appeared in the field of view. It lay like a little worm, obediently resting at the cecal tip, slightly edematous.

At this point, Zheng Ren's heart found its place and settled.

He carefully observed the appendix; in terms of size, the patient's appendix was relatively small, which probably also explains why it did not cause intestinal obstruction.

The appendix surface showed a bit of purulent exudate, congestion and edema; it was still early, estimated that perforation would occur only after at least 2–3 days.

The appendix surface shows a bit of purulent exudate, congestion, and edema; it's still early, estimated to take at least 2-3 days before perforation occurs.

Zheng Ren felt somewhat at a loss.

Zheng Ren was a little confused.

Not as if the appendix were outside the cecum, cut it, ligate it, pay attention to the appendix artery; afterwards it's just done.

Now the appendix is inside the cecum, the bowel has a twist, and even after opening it, removing it remains difficult.

Let's give it a try.

Zheng Ren began training to remove the appendix.

It seems he returned to the unstable time in the System Space; Zheng Ren went back to square one and started researching the appendectomy again.

……

……

"Zheng Lao Ban, would you come up and take a look?" Feng Jianguo asked softly.

"How long has the patient been fasting before surgery?" Zheng Ren suddenly asked.

"Six hours." Another team-leading professor said softly.

"Routine, no enema?"

"Hmm." The two team-leading professors and Director Wei were somewhat puzzled; Zheng Lao Ban wondered why he was asking so many questions.

"If we can't find it, it might be an intraluminal appendix; it's best to check with a colonoscope. But without an enema..." Zheng Ren had already determined it was an intraluminal appendix, but to open the bowel he needed a reason.

Director Wei's heart moved; he said, "Zheng Lao Ban, I've palpated. There's no intraluminal appendix within 6–8 cm above and below the cecum."

"Experience is truly rich," Zheng Ren thought. However, this patient's appendix location is extremely special, far from the cecum, so Director Wei couldn't feel it.

If it weren't for the System Operating Room, I could freely explore; otherwise I probably wouldn't find the location of this intraluminal appendix.

Thinking this, Zheng Ren asked, "Director Wei, have you checked all the intestines?"

"Hmm." Director Wei nodded.

"What about the retroperitoneum?"

"No hernia orifice either, not a retroperitoneal appendix." Director Wei sighed, as if Zheng Lao Ban's words were useless.

Zheng Ren glanced at the operative field and said, "We've already examined everything; I think the possibility of an intraluminal appendix is still high. Why not use a colonoscope to take a look?"

"Colonoscope?!" Director Wei was stunned.

"Hmm, assuming the diagnosis is fine, we've searched the peritoneal cavity and still haven't seen the appendix. Considering an intraluminal appendix is more likely, perhaps it's a positional variant. I suggest using a colonoscope to look; if we still can't find it, we'll think of another method."

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

"Prepare for intraoperative enema!" Director Wei approved Zheng Ren's suggestion, he was a bit excited and directly said, "Circulating nurse?"

The circulating nurse was dumbfounded.

Still need intraoperative enema? That would be troublesome.

Troubles are small; what could be more troublesome than a "missing" appendix?

The patient's position, sterile field, plus the enema operation…… what do we do with the waste that comes out?

"Wait a moment, Director Wei." Zheng Ren asked, "How many days has the patient been in pain before surgery?"

"Three days." Another team-leading professor said, "The diet is liquid, small amount. Probably… the bowel movements have mostly cleared."

"Let's try the colonoscope, no enema first. No need to do anything with the colonoscope, just take a look. If there's solid stool, we can still do an enema later." Zheng Ren said.

The head nurse let out a sigh.

"I'll do the colonoscope." Feng Jianguo said.

"Director Luo came up with me; he should be arriving soon, let Director Luo do it." Zheng Ren prepared to scrub up, then turned and said.

"Director Luo? What is he here for?"