In the observation room, the experts were puzzled.

In the operating room, Tang Lou had already held the disposable stone extraction basket in his hand.

The stone removal basket is composed of a nickel-titanium alloy wire basket, a sheath, and a control handle. The stone removal basket is generally used for large particles of feces.

As for this patient, under X-ray, it was clear that there were no large fecal stones, so everyone was confused.

Under the endoscope, Tanglou was seen controlling the handle of the stone basket, using his fingertips to rotate the basket slightly inwards.

"Hey, what is that?"

In the observation room, everyone was attracted by the scene under the endoscope. The stone removal basket rotated slightly in the appendix cavity, stirring up the fluid. Then they saw several thread-like things, which came loose and hung up.

On top of the wire of the basket.

Tanglou controls the strength and rotates clockwise. The linear objects slowly wrap around the wire of the basket, getting tighter and tighter.

Under the endoscope, you can still feel the thread-like objects moving, and the experts naturally understood it when they saw this.

Everyone's scalp is numb!

"It's the intestinal nematode Vermiformis!"

Professor Liu shouted out directly. Adult pinworms parasitize the ileocecal part of the human body, most commonly found in the cecum, appendix, colon, rectum and lower ileum.

When a person sleeps and the anal sphincter relaxes, some female bugs crawl out of the anus and lay eggs in nearby skin.

After laying eggs, the female worms usually die due to dryness, and a few female worms can peristalsis and migrate back to the intestinal cavity through the anus. Apparently, the female worms returned to the abdominal cavity and entered the appendix cavity, causing ectopic parasitism, abscess obstruction, and then acute

appendicitis.

Parasitic appendicitis also accounts for a large proportion of appendicitis in children.

However, no one expected that Tanglou would be so bold, using an ERAT catheter to suck out the eggs, and then use the metal wire of the stone extraction basket to wrap the adult worms and pull them out of the body.

In order to have enough space, the stone removal basket was stirred, the adult insects were entangled, and a plastic bracket was placed in advance...

At this moment, when I think back to the entire operation process of Tanglou and the preparation for the operation, all the experts have endless aftertaste.

"This can be regarded as another modified variant of ERAT, right?"

Huang, a well-informed doctor, was also stunned by Tanglou's unbridled creativity.

Under normal circumstances, appendicitis caused by vermiform nematodes is treated laparoscopically to directly remove the entire appendix that is parasitized by the worms.

Just like in movies and TV shows, after being bitten by a venomous snake, the bitten arm is immediately cut off to cut off the transmission path of the virus.

After using three disposable stone removal baskets, six 1-2 cm long adult worms were placed on the plate and were still wriggling.

The equipment nurse on the side didn't dare to take a second look, and the hair on their whole body stood up.

Even Ma En didn't dare to look at the plate. The thought of having such a bunch of worms in his abdominal cavity made Ma En feel sick.

"Second rinse with normal saline..."

After confirming that all the adult insects were entangled and hooked out of the stone-removing basket, Tanglou continued with the next step, without any emotional fluctuations due to such an astonishing move.

The equipment nurse frowned, not daring to approach, and carefully handed the equipment to Tanglou.

In order to thoroughly rinse away the remaining insect eggs, Tanglou naturally rinsed it carefully and repeatedly several times.

"Metronidazole, amoxicillin antibiotic preparation...and pay attention to postoperative prevention and treatment..."

Although infection is basically impossible under the BUFF of the surgical master, Tang Lou still asked Ma En, who would be responsible for subsequent follow-up and ward rounds, to pay attention to antibiotic prevention and treatment.

"Um."

Ma En nodded, but his heart couldn't calm down for a long time.

In ERAT, a stone basket is used to stir the pus through rhythmic rotation, thereby winding the adult worms on a wire and then lifting them out of the body. How did you come up with this!

Ordinary parasites can either be eliminated from the body by taking medicine, or the affected area can be removed once and for all. How can there be a non-invasive removal of parasites through pure physical means like Tanglou.

No textbook would dare to write this!

At this stage, the entire ERAT has been completed. The pus has been sucked out and the parasites have been caught. As soon as the anesthesia wears off, the patient can walk on the ground.

"sharp!"

In the observation room, the experts were also mentally shocked by another surgical performance that broke the rules.

Wen Dalong was completely silent. Even though he couldn't stand Tang Lou anymore, he still had to admire this kind of creative thinking.

This case can be devoted to a paper. Wen Dalong even thought of the title of the paper: In the treatment of pinworm appendicitis in children, non-invasive removal of worms through the stone basket during ERAT surgery.

Cheng Jian and Qingping were naturally a little surprised, but on the surface it was still very tight. Cheng Jian took a sip of coffee and said lightly: "Experts are laughing at you, this brat just doesn't worry. Routine operations, routine operations.

"

Hearing Cheng Jian's seemingly humble, but actually raised his tail to the sky answer, Wen Dalong almost spit out a mouthful of blood!

Qingping took the hot water kettle, filled Wen Dalong's tea cup to the bottom, and smiled at him.

In order to cover up his embarrassment, Wen Dalong quickly took a sip of hot tea.

An old face turned red from suppressing the pain. He suppressed the burning sensation and swallowed it. He also raised his thick lips toward Qingping slightly to express his gratitude.

The smile is uglier than the cry.

...

...

Without much pause, leaving only time for preoperative preparation for the next operation, Tanglou appeared in the operating room again.

Soon the third patient appeared on the operating table.

The patient's case information was sent to various experts.

Patient: Liu Fengjuan, female, 23 years old

Brief medical history: Due to "metastatic right lower abdominal pain for more than 2 days", he was admitted to the hospital with "the cause of abdominal pain is yet to be investigated (acute appendicitis?)".

He denied any special medical history in the past; he developed periumbilical pain more than 2 days ago without obvious triggers, which was persistent, dull distending pain, paroxysmal intensification, and no radiating pain. After a few hours, the pain transferred and became fixed in the right lower abdomen, with nausea and no vomiting.

There were no symptoms such as diarrhea, frequent urination, urgency, dysuria, gross hematuria, and cough.

Physical examination: T: 36.0℃, P: 84 times/min, R: 21 times/min, BP: 120/90mmHg;

The abdomen was obese and full, with no abdominal varicose veins, gastrointestinal pattern and peristaltic waves; McFarland point tenderness, rebound tenderness and muscle tension in the right lower abdomen.

No mass was palpable, the liver and spleen were not palpable under the ribs, and Murphy's sign was negative; abdominal percussion showed tympani, no percussion pain in the liver and spleen areas, no percussion pain in the kidney areas, negative shifting dullness, and bowel sounds 3

Times/minute, no sound of breath or water passing through was heard.

Auxiliary examination: Abdominal CT showed a tubular soft tissue density shadow of about 0.8cm in diameter in the ileocecal region, with fecal stones visible inside, exudative lesions around, increased adjacent fat density, and thickening of the retroperitoneum on the right side;

...

It was obviously a typical case of acute appendicitis. Since the patient was relatively young and liked to wear navel-baring clothes, I was still wondering whether to go to the provincial capital hospital.

When I heard that the first hospital in the city could perform non-invasive ERAT, I naturally chose to perform this procedure in my city right away.

Chen Wenhao soon gave the patient anesthesia. After completion, Tang Lou stood at the position of the surgeon.

Due to his talent, concentration and resilience, Tanglou was not affected at all. After two difficult surgeries, he felt like an athlete who had warmed up, and his whole body was full of energy.

The first step is still the most difficult intubation among all the steps of ERAT. After all, the position of the appendix is ​​highly variable, and the internal opening of the appendix is ​​not necessarily in the position facing the endoscope.

Sure enough, Tanglou, which had always had smooth sailing before, also encountered trouble with the intubation of this patient.

After pushing several times but unable to find the patient's Gerlach's valve, Tanglou frowned and paused slightly.

In the observation room, seeing the Tanglou for the first time, he stopped and thought. The experts became a little more interested, and finally the Tanglou was stumped.

But this idea itself makes these experts a little depressed...

"This patient's abdomen is likely to be obese and full, and the appendix is ​​directly wrapped by the intestinal fat hanging. If a conventional laparotomy is performed, it is necessary to dissect the fat hanging to see the appendix."

Dr. Huang carefully looked at the films on the case list and the endoscopic images on the screen, and put forward his own ideas.

As for the situation where the contrast catheter cannot be close to the internal opening of the appendix, it is no longer possible to enter by intubation alone. The experienced Dr. Huang has naturally encountered it before and knows how to deal with it, but this method requires another surgical operation.

Tools to solve.

Therefore, it tests the surgeon's divergent thinking and familiarity with various surgical instruments in the operating room.
Chapter completed!