Huang Zhilei wanted to scratch his head about this question. Brother Cao didn't say anything after he brought the child up, and he didn't know what the reason was and how to answer it.
The child was seriously ill. He should be sent to the emergency room instead of the office. There was no oxygen in the office.
A bunch of famous doctors are arguing about whether to give patients emergency drugs or to perform emergency intubation, cardiac compression, defibrillation, etc., but whether enema is useful.
"It's useless for you to just give him an enema," Jiang Mingzhu said. "If he doesn't want surgery for appendicitis, you can try to use a colonoscopy to check his intestines and appendix. Colonoscopy is more accurate and intuitive than CT. It can clearly identify whether there is fecal residue in the intestines. If there is, take it out and flush it to reduce inflammation."
(At that time, there was no endoscopic retrograde appendicitis treatment (ERAT). The principle of ERAT surgery is similar to the method mentioned by Jiang Mingzhu. It is a method of treating appendicitis by examining the appendix through endoscopy and taking feces for flushing. It is mainly aimed at appendicitis caused by residual fecal stones.)
In Xie Youtian's case, it is suspected that he has appendicitis caused by feces.
"You are too impatient. We just finished the enema and don't know what the effect will be. Let's wait and see if the situation changes later." Dr. Jiang from the General Surgery Department waved his hand at her suggestion.
"I'm not in a hurry. I'm thinking that if I decide not to perform a surgical procedure to remove the child's appendix and want to try other methods, I can make a plan for digestive endoscopic surgery in advance," Jiang Mingzhu said. Internists are more careful and advocate the need to plan ahead.
Yu Xuexian responded to her words: Yeah.
...
...
The surgeon disagreed after hearing what the two digestive doctors said and refuted:
"Your endoscope is fine for examinations, but it's fine for other treatments. The appendix is a very special area. It's very difficult for you to get the endoscope to the appendix. This child will definitely not cooperate, and he needs anesthesia, otherwise he can't do it."
"The endoscopic examination method you mentioned is not much different from conservative treatment. If the inflammation is minor, it will naturally dissipate under conservative treatment. The child will have blood drawn and an injection later. If the inflammation is severe, it is impossible to eradicate the inflammation of this area by just flushing it twice. Antibiotics must be treated for a sufficient course of treatment to be effective. In severe cases, our surgery department will perform incision, open drainage and flushing at the suppurative area. It cannot be done in one go and requires multiple times. Therefore, the appendix is very prone to recurrence, and ultimately only surgery can be performed to remove it once and for all."
(Future ERAT surgery will also have this shortcoming and will have certain requirements for indications.)
It is not easy to preserve the appendix.
The surgeon's confidence in conservative treatment today is mainly based on the fact that the child's condition was discovered relatively early.
After being yelled at by the surgeon, Jiang Mingzhu took two breaths, thought about it again, and insisted on her opinion as an internal medicine doctor.
Not only the gastroenterologist but also Doctor Lin from the cardiology department spoke up: "The child's heart rate and breathing rate are fast. It is difficult to tell whether this is simply caused by fear. Because he is in pain and has a fever, these will increase his heart rate and breathing rate. If you want to feel more at ease, let him stay in the hospital for observation, right?" After saying that, he looked at Jin Tianyu.
Jin Tianyu's situation is not as simple as his colleagues think. The issue of enema alone has caused such a fuss. If the child is hospitalized, which department should he be arranged to go to?
Besides, don’t you have any objections?
Fu Xinheng didn't say anything.
Zhu Huicang adjusted his glasses and asked, "The attending doctor is still silent?"
The opinions of various departments are all here, and the right approach is to let the attending physician make the final decision.
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