Reduction, a term most often heard by laypeople in orthopedics, for example, joint realignment. A dislocated joint is realigned through manual techniques by the doctor. From this, the meaning of reduction is easily understood; in medical terms, it means restoring the organ to its original normal state.
In the case of intussusception, to bring the telescoped intestine back to its original state, the most straightforward and immediate method that comes to mind is for the doctor’s hand to go in and straighten the folded intestine. Such a situation requires surgery.
Duan Sanbao knows that Student Xie’s suggestion definitely does not refer to surgery. It’s not that the conditions are lacking—Shou’er Emergency Department is equipped with an emergency operating room for urgent surgeries; however, there are no specialist doctors.
If an emergency doctor has the capability to treat the case themselves, it earns them respect. In fact, usually, emergency doctors can only safeguard the child as much as possible until the specialist arrives. They are not pediatric general surgeons who perform surgeries.
Is there absolutely no way without surgery? Many previous medical cases have mentioned that medicine and other engineering disciplines have striking similarities. Without surgery, if the doctor’s hand doesn’t go in to realign the folded intestine, tools can be used following engineering principles to solve the problem.
Speaking of intestines, they are somewhat like rubber tubes. Apart from pulling and straightening folded rubber tubes using external forces, often inflating a concave piece of rubber can employ another method called inflating.
Thus, inflating in reverse within the intestinal cavity can be attempted, using the impact of the gas to force the folded segment that has been telescoped to retract. Clinically, this method of intestinal reduction is known as air enema.
Due to the direction of intestinal peristalsis waves moving downward, most cases of intussusception align with the activity of the peristalsis waves, telescoping from proximal to distal. The inflation must be done inversely, from the distal end. Starting from the distal end means the body’s distal intestinal outlet, which is the body’s anus, is where the air is introduced into the bowel.
Inflating within the human body is a high-risk operation, and the doctor must perform it under visual monitoring.
To observe the condition of the entire intestines after inflation without opening the abdomen, an ultrasound is definitely not suitable. Ultrasound can only conduct localized observations. We can think of using the closest surgical real-time monitoring method. Yes, it’s interventional surgery.
Like interventional surgery, employing an X-ray imaging system allows real-time surgical monitoring at any time. Although barium meal imaging for examining intussusception is considered dangerous and has been phased out. Air enema is unlike barium meals, as it introduces air instead of indigestible barium agents, making it relatively safer in terms of safety. Overall, Student Xie referred to the fluoroscopically guided air enema reduction method.
Student Wei quickly interjected: "I know, Yingying is referring to using an air enema."
Student Xie Wanying thought: Every time Wei responds quickly to pediatrics, it reveals special interest. Classmates say Wei’s grades are average; only Wei’s interest in pediatrics could explain this. Why does Wei deny it, perhaps this denial is a strategy to mislead?
"Do you not know about air enema?" Seeing no response from Duan Sanbao, Wei Shangquan questioned what this Guodu top student was thinking.
The attending doctor is clearly concerned. Understanding young doctors’ multiple concerns is natural, as young doctors have less hands-on experience and lack confidence. At present, the occurrence of intussusception in this young patient might exceed 48 hours, and the elders at home discovered the abnormalities too late.
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