Famous Among Top Surgeons in the 90s

Before taking medical measures, in non-resuscitation situations you must first hurry to clarify the diagnosis.

When suspecting intussusception and choosing an auxiliary examination, the textbooks used to usually recommend a barium meal.

That was because back then there was a shortage of ultrasound machines and CT scanners, and only X-ray machines were relatively abundant.

Advances in medical technology have given doctors more options and allowed them to phase out inappropriate examination methods.

Take the barium meal, for example: it’s actually quite unsuitable, because intussusception causes bowel obstruction, and doing a barium meal on top of that only worsens the obstruction.

CT involves radiation; ultrasound is the first choice as it is quick and convenient.

The emergency department of Shou’er has an ultrasound room. Carrying the child over for a scan is the fastest.

Several people carried the child to the ultrasound room. Because this child’s condition was relatively urgent, they explained the situation to the other children and parents waiting in line, then directly cut in to do the scan first.

There are four typical symptoms of intussusception. One is paroxysmal abdominal pain, manifested as the child crying and fussing and then quieting down. The second is vomiting, which this child has. The third is "currant jelly" stool, that is, stool with blood and mucus, which this child does not have. The fourth is a sausage-shaped mass, which is present.

With only two out of four symptoms, it can only be called a preliminary suspicion; instrument-based auxiliary examination is a must. Signs like vomiting and a sausage-shaped mass indicate bowel obstruction, but are not necessarily caused by intussusception. For example, another common pediatric disease in clinical practice is ascariasis. A ball of roundworms can likewise cause bowel obstruction, though the onset age is usually older, in big kids, and indeed this disease typically does not have bloody stool. When a doctor palpates the mass, a roundworm bolus feels like cord-like structures on the surface. That’s what the books say, but relying on the doctor’s tactile impression—each doctor’s "feel" is different—it really is like Schrödinger’s cat, hard to describe clearly.

Ultrasound is much more intuitive. Based on the mechanism of intussusception, ultrasound can detect a phenomenon of a large ring encasing a small ring, called the "concentric circle sign."

The clinicians stood around behind the ultrasound doctor, watching along. On the machine’s screen appeared two low-echo masses nested together, with a high-echo band in the middle.

"It should be intussusception." The ultrasound doctor at Shou’er had seen countless cases of this disease and knew it inside out; a few sweeps of the probe were enough to make the call.

To be on the safe side, they then swept over the child’s appendix. Acute appendicitis is likewise a very common and easily overlooked acute abdomen in infants and young children. The appendix is connected to the cecum, so its location is close to where this disease occurs, and the two need to be differentiated.

After scanning, the child’s appendix was fine. If one wanted to be even more cautious, a CT scan could be done, but CT takes more time, and since there was already a fairly definitive test result, there was not much need to add a CT.

A good doctor can save the patient and family some money.

The focus now shifted to the next step in medical management.

If intussusception is severe enough to cause bowel necrosis, an immediate operation is required to cut out the necrotic segment and perform an enteroenterostomy. The emergency nurse was notified to call down the pediatric general surgery doctors from the inpatient department to see the child and make a decision.

It just so happened that today was the first day all staff returned to work at the hospital, the busiest time for everyone. Many surgeries delayed by the holiday had been scheduled in a rush; the previous day’s operating list was packed full. Reportedly, all the pediatric general surgeons were in the operating room, and it would take some time to reach them and get them to come down.

Before the inpatient department staff came down to take over the patient, the doctor in charge remained the emergency admitting doctor.

Seeing that the child’s condition was tending to worsen, Xie Wanying suggested, "Why don’t we make use of this time and try to reduce the intussusception for the child, Doctor Duan?"

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