Chapter 2167: Chapter 2167: Indications
Regarding this issue. Huang Zhilei wanted to scratch his head. After Senior Cao brought the child up, he didn’t say anything, and Huang couldn’t figure out the reason or how to answer.
If you say the child is critically ill, a critically ill patient should be sent to the emergency room, not the office. The office doesn’t even have oxygen.
The group of renowned doctors wasn’t debating administering emergency medication or performing emergency intubation, cardiac compressions, defibrillation, etc... but whether the enema was effective.
"You surgeons just giving him an enema is not going to be effective." Kang Mingzhu said, "If he has appendicitis and doesn’t undergo surgery, it might be worth trying a colonoscopy to check the intestines and appendix again. A colonoscopy is more accurate and direct compared to a CT, as it can clearly discern if there is fecal residue in the intestines, which if present, can be removed, and then irrigated and treated with anti-inflammatory measures."
(At that time, the ERAT endoscopic retrograde appendicitis treatment procedure was not yet available. The ERAT surgery principle is similar to what Kang Mingzhu mentioned, which involves checking and removing fecal stones from the appendix through endoscopy to treat appendicitis, especially targeting cases caused by fecal stone residue.)
Indeed, in Xie Youtian’s case, appendicitis caused by fecal residue was suspected.
"You’re too hasty; we just finished the enema and don’t know the effect yet. Let’s wait and see if there’s any change in the situation before discussing further." Doctor Jiang from the General Surgery Department One waved at her suggestion.
"I’m not rushing. I was thinking, if we decide not to plan surgical removal of this child’s appendix, and want to try more alternative methods, it’s better to prepare in advance for the possibility of a gastrointestinal endoscopic procedure," Kang Mingzhu said. Internists are a bit more meticulous and advocate for being proactive.
Yu Xuexian’s response to her words was: Hmm.
The surgeons didn’t agree after hearing what the two gastrointestinal doctors had to say, and refuted:
"Your endoscopy inspection is okay, but for other treatments, it’s generally very limited. The appendix is a very special area. It’s very difficult for your endoscope to reach the appendix. The child definitely won’t be able to cooperate; anesthesia is required, or it can’t be done."
"Your described method of endoscopic inspection and conservative treatment isn’t significantly different. If the inflammation is minor, it will naturally subside with conservative treatment. Later, we also need to draw this child’s blood and give him injections. If the inflammation is severe, just flushing it like this a couple of times can’t possibly eradicate the inflammation in that area. Antibiotics take an adequate duration to be effective. If it’s serious, we surgeons will perform an incision, open drainage, and irrigation of the suppurated area, which can’t be managed in one go and needs multiple attempts. Therefore, the appendix area is very prone to recurrence, and in the end, surgery to remove it is the only definitive solution."
(Future ERAT surgeries also have this flaw, having specific requirements for indications.)
It’s very challenging to preserve the appendix.
The surgeons’ confidence in conservative treatment at present mainly stems from the relatively early detection of this child’s condition.
After being shouted at by the surgeons, Kang Mingzhu took a couple of deep breaths, thought again, and stuck to her internal medicine opinion.
Not only gastrointestinal, but also cardiology doctors were present, and Doctor Lin from cardiology spoke: "The child’s heart rate is relatively high, and his breathing rate is fast. This situation makes it hard to say whether it’s simply due to fear. Because he’s in pain and has a fever, all these would increase his heart and breathing rates. If you want peace of mind, why not have him admitted for observation?" After speaking, he looked at Jin Tianyu.
Jin Tianyu didn’t think as simply as his colleagues; just the issue of the enema had caused such a dispute here, if this child were to be admitted, which department should he be arranged to?
Besides, does the cardiothoracic department have no opinion?
Fu Xinheng remained silent.
Zhu Huicang adjusted his glasses: "Is the attending physician still not speaking?"
All the department opinions are here, letting the attending physician make the final decision is the correct path.
