Come on, Dr. Wu

Chapter 268 Giving birth to a baby without an anus!

At this time, Wu Xiaofu had already arrived at the Obstetrics and Gynecology Department.

Director Jin of the Obstetrics and Gynecology Department said that they had encountered a special patient and needed a consultation with the Hepatobiliary Surgery and Pediatrics Departments. Wu Xiaofu happened to be there, so he went along.

After arriving, Wu Xiaofu discovered that this child was obviously more troublesome.

Congenital anal atresia combined with fistula is an extremely dangerous disease, ranking first among congenital gastrointestinal malformations, with an incidence rate of about 1/5000-1/1500.

The incidence rate is even higher than the congenital intestinal volvulus we just saw, and it is more urgent.

The types of congenital anal atresia include anal membrane atresia, congenital anorectal stenosis, internal rectal atresia and anorectal atresia. The main manifestations are no meconium discharge, vomiting, abdominal distension, etc.

To put it in a more vulgar way, it's really like what people usually swear, that the baby will be born without an anus.

Children should basically have bowel movements once a day. Once this condition occurs, if it is not treated in time, it may cause serious complications such as urinary tract infection, intestinal perforation, intestinal necrosis and toxic shock.

The congenital intestinal volvulus just now was delayed for two months and there was still a chance for treatment, but this one cannot be delayed even for a week.

"I need surgery as soon as possible."

After examining the child's condition, Wu Xiaofu said something and looked around. Director Jin from the Obstetrics and Gynecology Department and the child's mother were also there.

As soon as Wu Xiaofu finished speaking, Director Jin hurriedly introduced Wu Xiaofu to the child's parents.

After hearing Director Jin's introduction, the child's parents hurriedly thanked Wu Xiaofu and expressed their absolute trust in Wu Xiaofu, asking him to save the child.

Unlike Qiqi's parents, Xiaoyu's parents have been in the hospital for several days. They moved in three or four days before the child was born. Now Wu Xiaofu is the topic of discussion in Jinhu County Hospital.

Xiaoyu's parents have heard the doctors, nurses and even patients in the hospital talk about Wu Xiaofu countless times in the past two days. They were curious and checked it out. They were even more surprised. They decided to have their child study medicine after he is born and grow up, and become a great doctor like Wu Xiaofu in the future.

Seeing that the child’s parents had no objections, Wu Xiaofu also promised to do his best.

"Director Jin, please help me prepare for the surgery and notify the operating room. The surgery will be anorectal surgery + fistula removal. Local anesthesia will be enough. I will tell the child's parents about the precautions for the surgery."

"it is good."

After hearing what Wu Xiaofu said, Director Jin was also somewhat excited. She felt the same as Director Huang. This operation would serve as a publicity point for their obstetrics and gynecology department, and she could also learn along the way. In the future, Jinhu County Hospital could use this to win the trust of more patients.

Xiaoyu is a one-day-old baby whose organs are still in the initial development stage. The difficulty of surgery cannot be compared with that of an adult and is directly increased by several levels.

The blood vessels and tissues of infants are relatively fragile, their physiological functions have not yet stabilized, and their tolerance for surgery is low. This requires the surgeon to be very precise in his or her operation, accurately finding the entry point while avoiding damage to surrounding tissue structures.

In addition, the requirements for anesthesia are more stringent, and it is necessary to ensure that the anesthesia effect meets the surgical requirements while not affecting the baby's vital signs.

All of these will be done by Wu Xiaofu in the future. Needless to say, it is dangerous. Although Wu Xiaofu is confident, he still needs to explain everything to the child's parents.

Inside the medical office, Wu Xiaofu listed all the risks one by one, as well as the different difficulties of anesthesia and surgery for infants and adults. Xiaoyu's parents became more and more nervous as they listened, and the couple clenched their hands tighter and tighter.

"Are you all okay with this?"

After Xiaoyu's parents calmed down after hearing this, they suddenly looked at Wu Xiaofu and said, "Doctor Wu, we believe you."

What doctors like most is the feeling of being trusted. Of course, this is also a heavy responsibility. Whether it is the patient or the patient's family, since they have chosen to trust you, then as a doctor, you dare not let this trust down in any way.

"Okay, then I'll go prepare for the surgery. You guys just wait for me outside the operating room."

As I walked out of the medical office, Director Huang from the Pediatrics Department came to greet me.

"Doctor Wu, Qiqi's parents have also decided to have the surgery here. What do you think?"

"Okay, let's start preparing for the surgery. Xiaoyu's surgery should be completed quickly, and then we can just bring it in directly."

As he spoke, he looked at Director Huang and said, "Director Huang, I don't need to explain the risks. You need to explain it clearly to the family. It has been delayed for too long. If the intestines really need to be removed, you need to be mentally prepared. The child's parents will definitely not be able to accept it. You need to do more work to persuade them."

"Okay, Dr. Wu, don't worry."

In the operating room, the obstetrics and gynecology department moved very quickly. Director Jin of the obstetrics department assisted Wu Xiaofu. After the local anesthetic was prepared, the operation began directly.

This operation requires speed and accuracy. The precise anatomical positioning must be determined quickly, and then the incision, separation of the closed blind end of the rectum and construction of a new anus must be started.

Because general anesthesia is not used during the operation, the child will inevitably be fussy, which is also one of the difficulties of the operation. Therefore, the operation must not be delayed, so an additional operating nurse is added to comfort and control the baby.

To be honest, the job of nurses who specialize in assisting in pediatric surgery is still very hard.

Especially when it comes to surgery under local anesthesia, the scene is, well, very difficult to bear.

However, because of this, they have also developed their own skills. When facing a child, Wu Xiaofu is at a loss, but this nurse can quickly calm the baby with just a few moves.

They know what to do to make their baby more comfortable.

This is not the first time Wu Xiaofu has performed anal reconstruction, and patients with rectal cancer often encounter this situation.

Therefore, for Wu Xiaofu, the surgical operation is not a problem; intraoperative maintenance is the key.

The baby's body temperature must be kept constant throughout the operation, and the doctor must be prepared to deal with emergencies such as sudden bleeding during the operation.

The capillaries of infants are too fragile and can be easily broken even with normal operations, let alone anal reconstruction.

Even though Wu Xiaofu operated carefully, there was still blood seepage. If this blood seepage continued to increase, it would affect the baby's body fluid circulation, which is different from that of adults.

This was also the first time Director Jin had experienced such a patient and such an operation, so he seemed very nervous.

But after seeing Wu Xiaofu's operations, he gradually calmed down.

Wu Xiaofu's operation went too smoothly. Although there was a little blood oozing out, Director Jin looked at the progress and was afraid that Wu Xiaofu would be able to complete the operation before any minor problems arose in the baby.

Sure enough, forty minutes.

It took only forty minutes from the start of the operation to the completion of Wu Xiaofu's anal reconstruction.

"Doctor Wu, your operation really amazes me."

Director Jin was not an ignorant person. Although he had never performed the operation himself and had even served as an assistant in such an operation, Director Jin had gone to study and had seen some similar operations. However, compared with Wu Xiaofu, the operations in his mind seemed like reality reflected in the image. Director Jin inevitably had the urge to copy and paste. Unfortunately, he could only think about it.

"There are too few cases like this. Otherwise, let Director Jin try it. Maybe he can train it with a few machines."

Director Jin was moved when he heard this, but his expression dimmed. Even if he encountered this one case, he was extremely lucky, not to mention that he encountered several of them. Director Jin has been teaching for 20 years, and this is the first one. Even in the provincial capital, there wouldn't be too many.

This may be the only assistant experience in her life.

Thinking of this, Director Jin looked at Wu Xiaofu with even more burning eyes. She had been foresighted enough to ask the doctors in the department to help her take a video. After returning, she ordered a model and learned the operations according to Wu Xiaofu's video. If she encountered the same operation in the future, perhaps she would be able to perform it.

Wu Xiaofu did not delay any longer. He checked the baby's condition again and confirmed that everything was going well. There were no other systemic complications immediately after the operation. He was completely relieved and walked directly out of the operating room.

"Doctor Wu, Xiaoyu?"

Xiaoyu's parents, who were waiting outside the operating room, saw Wu Xiaofu coming out, and rushed over to him, asking tentatively, their eyes filled with fear, for fear that they would get some sad answer from Wu Xiaofu.

Wu Xiaofu could understand their feelings and smiled more. "Don't worry, the operation went smoothly. You will stay in the hospital for a few days for observation. If there is no problem, you can be discharged. Xiaoyu will be the same as a normal child in the future."

call!
After hearing Wu Xiaofu's words, Xiaoyu's parents breathed a sigh of relief. The operation was successful and their child was saved.

"Thank you, Doctor Wu, thank you."

In the sight, two other figures also came over at this time.

"Doctor Wu, Qiqi has already gone in. We are really sorry to trouble you this time. We didn't mean to hesitate just now. We..."

Qiqi's father looked at Wu Xiaofu with a little ashamed. Qiqi had made the preoperative arrangements and was sent to the operating room in the middle of Wu Xiaofu's operation. He should have been making preparations at this time. Qiqi's parents were also waiting anxiously outside the operating room.

In the entire hall, there were only Qiqi's parents and Xiaoyu's parents, so it was inevitable that they would have a conversation.

Only then did Qiqi's parents realize that Xiaoyu's parents actually suffered the same disease as them. Although their conditions were different, they both suffered congenital diseases and their moods were roughly the same. Seeing that Wu Xiaofu had successfully completed Xiaoyu's surgery so quickly, they became more confident in Wu Xiaofu.

I just feel a little embarrassed when I think of my previous hesitation. After all, everyone has experienced the feeling of not being believed and knows how painful it is.

Wu Xiaofu didn't care. After all, this was human nature and it was not the first time he had encountered such a thing.

"It's okay. I understand. Don't worry. Qiqi's surgery will start soon. Just wait and see."

After comforting Qiqi's parents, Wu Xiaofu returned to the operating room without much delay.

Gastrointestinal radiography combined with barium enema is the gold standard for diagnosing intestinal malrotation. It can show that most of the colon is located in the left abdomen and the cecum is located in the upper abdomen or left side. However, this examination is somewhat inappropriate for children, so Wu Xiaofu did not ask Fan Xin to prescribe this examination.

However, a plain abdominal X-ray is still necessary.

When entering the operating room, Fan Xin had already handed over the abdominal X-ray film. When it was unfolded, it could be clearly seen that the stomach and the first section of the duodenum were dilated and had a fluid level, and there was only a small amount of gas in the small intestine.

"The condition is the same as we diagnosed before, but it doesn't seem to be as bad as we said. It should not be to the extent of necrosis."

Looking at the film, Wu Xiaofu spoke slowly, secretly relieved in his heart.

The baby is only two months old. If intestinal necrosis really occurs and resection is required, Wu Xiaofu feels a little reluctant to do so.

"let's start."

The anesthesiologist followed the convention and chose spinal anesthesia. Since Qiqi was only two months old, the risk of anesthesia was very high, so the deputy director was also pulled back. Other anesthesiologists really didn't dare to take this anesthesia.

Moreover, when administering anesthetics through an indwelling needle, the amount must be controlled accurately and the response must be quick.

Fortunately, the anesthesia went smoothly, and Wu Xiaofu did not delay. He washed his hands and started the operation. After all, it was a pediatric operation. Director Huang wanted to be an assistant, and Wu Xiaofu did not refuse.

Compared with Xiaoyu's surgery, Wu Xiaofu's surgery seemed to be performed more urgently.

The patient was in the supine position and a right median transrectus abdominis incision was made. The abdominal cavity was opened and the intestine was quickly freed, and the twisted and dilated small intestine was soon seen.

If you look closely, you can see that the small intestine is already congested and has a bluish-purple appearance. Wu Xiaofu's opening is not large, and from this angle, the right colon, cecum, and appendix cannot be seen.

hiss!
Whoa whoa whoa!
Director Huang couldn't help but gasp when he looked at the condition of the small intestine. It was really dangerous. Even if Qiqi had come a few days later, the intestine might have really been necrotic. It was lucky now.

Looking at Wu Xiaofu, perhaps it was even more fortunate that Qiqi met Wu Xiaofu.

After all, even if there is no necrosis in the small intestine, the difficulty of this operation is extremely high. With Wu Xiaofu's surgical efficiency, I am afraid that the risk of the operation can be reduced to a minimum.

Because it was local anesthesia, Qiqi was naturally conscious. Babies are not like adults who can control their crying.

As he cried, Wu Xiaofu's operation went faster.

Gently pull the entire small intestine out of the incision, turn it upward and protect it properly. You can find that the root of the mesentery is stalk-shaped, and most of the small intestine is suspended in the abdominal cavity with the root of the mesentery as the axis.

Qiqi's small intestine twisted in a clockwise direction, twisting twice.

The most shocking thing was that a section of the terminal ileum was entangled at the root of the twisted mesentery.

Wu Xiaofu asked Director Huang and Fan Xin to help protect it, and then gently rotated the twisted small intestine counterclockwise to relieve the obstruction. The effect was very obvious. After the rotation and reduction, the color of the small intestine quickly changed from bluish purple to normal light red.

Seeing this scene, Wu Xiaofu, Director Huang, and others couldn't help but laugh.

Necrosis is not just what can be judged by the naked eye. If the blood circulation of the small intestine cannot be restored after rotation and reduction, it may be inevitable to remove a section of it. The current situation is the best result.

After the intestinal volvulus is reduced, it is necessary to check the duodenal bulb and descending part, and push the small intestine to the left so that the incompletely rotated cecum, appendix and ascending colon can be seen in the right upper abdomen or upper middle abdomen.

Peritoneal cords can also be seen starting from the lateral edges of the cecum and ascending colon, crossing and compressing the descending duodenum, and ending at the lower edge of the liver, gallbladder and right abdominal wall, causing obstruction and dilation above the descending duodenum.

What Wu Xiaofu needs to do next is to cut the peritoneal cord, so as to relieve the pressure on the descending part of the duodenum.

At this point, the operation is almost complete.

After the peritoneal cord is completely cut, the duodenum is completely free. The duodenum is located on the right side of the abdominal cavity, while the cecum and ascending colon are located on the left side of the abdominal cavity. This is what doctors call the fetal position of the small intestine and colon. Once this intestinal arrangement is completed, the purpose of the surgery is achieved.

"It's done!"

(End of this chapter)