18: Chapter 18 Acute Appendicitis, Suppurative Stage
Lu Chen's fingers pressed lightly on the lower right abdomen again; this time, it was the Psoas sign.
The boy flinched in pain once more.
All physical signs pointed to the same diagnosis.
acute appendicitis, Suppurative Stage.
This diagnosis was actually not difficult; classic Migratory lower right abdominal pain plus McBurneys point tenderness and Rebound tenderness were textbook standard presentations.
But the key was not the diagnosis, but the management.
For Suppurative appendicitis, the risk of conservative treatment was too high; the safest option was surgery.
"Sir, my preliminary assessment is that this is acute appendicitis, and it may have already reached the Suppurative Stage."
"I need to order a blood count and an Abdominal CT for him first. Once confirmed, we'll arrange surgery as soon as possible."
The Middle-aged man's face suddenly turned pale.
"Surgery? Is it that serious?"
"Appendectomy is a very mature procedure, so don't be too nervous. However, if it's not handled in time, there's a risk of the appendix perforating, which would be even more troublesome."
"Then, then let's get the tests done quickly!"
Lu Chen nodded, turned to the computer, and issued the examination forms.
Complete blood count, Abdominal CT.
Then he picked up the phone and dialed Zhao Yaqin's number.
"Teacher Zhao, there's a patient with Acute abdomen here in the Green Zone."
"My preliminary diagnosis is acute Suppurative appendicitis. I've already ordered a blood count and Abdominal CT. Is it convenient for you to come take a look?"
It was very noisy on Zhao Yaqin's end; the Yellow Zone was clearly very busy.
"Suppurative appendicitis? Are you sure?"
"Positive McBurney's point tenderness, positive Rebound tenderness, positive Psoas sign, Migratory lower right abdominal pain, and a temperature of 37.8. It's basically certain. The CT is mainly to rule out other possibilities and assess the degree of suppuration."
Zhao Yaqin was silent on the other end of the phone for two seconds.
"I can't get away. Three patients arrived at the same time in the Yellow Zone. You handle it first, and call me directly once the test results are out."
"Understood."
Lu Chen hung up the phone and looked back at the boy on the examination bed.
The boy was sweating profusely from the pain, but his mental state was okay.
"Bear with it for a moment. The tests have been ordered. A Nurse will come to draw your blood in a bit, and then you'll go for the CT."
Lin Xiaoyu quickly came over to draw blood and then contacted the CT room.
While waiting for the results, Lu Chen began writing the medical record on the nearby computer.
He wrote very quickly; the chief complaint, history of present illness, physical examination results, and preliminary diagnosis were all clearly organized.
About forty minutes later, the test results came out.
Blood Count: White blood cell count 15.2×10⁹/L, neutrophil ratio 86%.
Abdominal CT: Appendix enlarged, approximately 1.2cm in diameter, thickened wall, a small amount of exudate visible around it, uneven density within the appendiceal lumen, suggestive of acute Suppurative appendicitis.
It was completely consistent with the system's diagnosis.
Lu Chen picked up the phone and called Zhao Yaqin again, reporting the test results.
After listening, Zhao Yaqin said one thing.
"It is indeed Suppurative appendicitis. It needs surgery. Contact the General Surgery Department and have them come down to pick him up."
"Understood."
Just as Lu Chen was about to call the General Surgery Department, the phone at the Nurse Station rang first.
Lin Xiaoyu picked it up, and her expression changed after listening for a few moments.
"Dr. Lu, the General Surgery Department said they only have one attending and one Resident Physician on duty today."
"There are currently two surgeries being performed simultaneously in the Operating Room, and they can't fit him in. The earliest will be in two hours."
Two hours.
Lu Chen glanced at the boy's condition and then pulled up the system's diagnosis in his mind.
[Warning: If not handled promptly, the appendix may perforate within 6 to 12 hours, causing Diffuse peritonitis]
The boy had already been in pain for over six hours, and the condition of the appendix was continuously worsening.
If they waited another two hours, the risk of perforation would increase significantly.
Once it perforated, the surgical difficulty would double, and the probability of postoperative complications would also rise sharply.
He picked up the phone and called Zhao Yaqin.
"Teacher Zhao, General Surgery can't fit him in for at least two hours. This patient's appendiceal suppuration is quite severe; I suggest we don't wait."
From Zhao Yaqin's end came the sound of hurried footsteps and the beeping of instruments.
"Then what do you mean?"
"The Emergency Department has laparoscopic equipment, right?"
Zhao Yaqin's voice suddenly paused.
"You want to do it yourself?"
"I'm confident."
There was three seconds of silence on the other end.
"Lu Chen, you're a newcomer."
"I know, but this patient can't wait two hours."
Another three seconds of silence.
"Wait there, I'll call Director Li."
Zhao Yaqin hung up the phone.
Lu Chen put down his phone and walked back to the boy's side.
The boy's complexion had worsened a bit more, and he was sweating even more.
"Doctor, is my condition very serious?"
"It's not serious, but you need surgery as soon as possible."
"I'm a little scared."
Lu Chen looked at him, his voice steady.
"There's nothing to be afraid of. Appendectomy is one of the most basic surgical procedures; it's very safe. Once it's done, it won't hurt anymore."
"Really?"
"Really, trust me."
The boy looked into Lu Chen's eyes, and for some reason, the sense of fear in his heart lessened significantly.
This young doctor's gaze was too steady—so steady that he didn't seem like a newcomer.
...
Five minutes later, Lu Chen's phone rang.
It was a call from Director Li Sen.
"Lu Chen, Zhao Yaqin told me. You want to perform the surgery on that appendicitis patient?"
Director Li Sen's voice was neither rushed nor slow, but his tone carried a sense of scrutiny.
"Yes, Director Li. The patient's appendix has reached the Suppurative Stage. The CT shows significant wall thickening and increased surrounding exudate. If we continue to wait, the risk of perforation is very high."
"You're a newcomer; have you ever performed laparoscopic surgery?"
Lu Chen was silent for a second.
"I haven't."
This was the truth; he had indeed never performed laparoscopy on a real operating table.
But in his mind, he had a complete set of Master-level experience for Laparoscopic Appendectomy.
Every step and every maneuver was crystal clear.
"Then what makes you say you're confident?"
"I've done full laparoscopic operation training in the school's simulation lab. I'm very familiar with the process of an appendectomy."
This wasn't a complete lie; the knowledge and muscle memory instilled by the system were essentially equivalent to high-intensity training.
Director Li Sen was silent on the other end for a long time.
So long that Lu Chen thought he was going to refuse.
Then Director Li Sen spoke.
"I'll be at the Operating Room in ten minutes to act as your teaching supervisor."
"You'll be the Lead Surgeon, and I'll be watching from the side."
"If anything goes wrong at any step, I'll take over immediately. Do you understand?"
Lu Chen's heart skipped a beat.
"Understood."
"Also, my name will be listed as the Lead Surgeon on the surgical record, and you'll be the First Assistant. Just keep this between us; don't go telling people outside."
"Understood."
"Go get ready."
The call ended.
Lu Chen took a deep breath.
Director Li Sen's willingness to come meant he was at least giving Lu Chen a chance.
But at the same time, it showed that Director Li Sen still had reservations about his ability.
If this surgery was done well, it would be a stepping stone.
If he messed it up, his path in the Emergency Department might come to an end.
"There is no possibility of messing it up."
Lu Chen said to himself in his heart.
Then he turned and began to prepare.