Chapter 2338: Far More Than That
As soon as Doctor Yang spoke.
Student Wei was the first to widen his eyes: What? Not possible? Why not?
How can it suddenly be impossible? If it doesn’t work, this child will have to be taken to the operating room for surgery.
What does Student Xie say?
We must first listen to what the experienced Doctor Yang has to say.
The schematic diagram of the pathological anatomy of intussusception is like this. It was mentioned earlier that intussusception occurs when a segment of the intestine folds into the inner diameter of another segment, and the structure of intussusception can thus be divided into:
The outer layer is the outer tube called the sheath, which is the outer diameter of the inserted intestine. The head of the sheath is the neck opening, similar to a bag opening, holding the folded intestine inside. The middle layer is the middle tube, where the folded segment of the intestine enters the neck opening. The frontmost part here is called the head of the intussusception. The innermost layer is the inner tube, where after folding and entering the opposite pocket, the intestine must fold back.
According to the folded segment, intussusception can be divided into various types: jejunum into jejunum, ileum into ileum, ileum into cecum, ileum into colon, and colon into colon, etc.
The most common type, as in today’s patient, is ileum into cecum.
Do you think it’s over when the ileum folds into the cecum? No, it’s not. The mechanism of intussusception involves intestinal function disorder leading to unhealthy movement. Before this unhealthy movement is corrected, the intestines will continue to move, and it might swing more violently due to intussusception, attempting to escape the confinement.
The intestines want to live, not die, which is the body’s self-protection mechanism.
The problem is that intestines, unlike a person’s hands and feet, cannot be directed by the brain; they move randomly without brain control. The result of random movement is like a drowning person who doesn’t know how to survive, moves chaotically, leading to sinking faster and dying quicker.
Intussusception is the same. The intestine moves chaotically, making it hard for the head of the intussusception to retract on its own, and the intestines will continue to move forward, potentially resulting in deeper intussusception. Outside the intestine is the mesentery; the deeper the intussusception, the more layers of the mesentery are pulled into the space between the outer and middle tubes and the middle and inner tubes. Besides tethering the intestines, the mesentery contains important structures like blood vessels that provide nutrition to the intestines. After deep intussusception, blood vessels get trapped in the middle layer, and the intestines lacking nutrition are more likely to necrotize.
According to the above principle, during ultrasound examination, the doctor specially instructed the ultrasound technician to scan the appendix. Firstly, for fear of appendicitis. Secondly, surgeons fear the appendix might also get intussuscepted.
This situation is not uncommon in clinical practice. These body parts are close to each other. After ileum into cecum, the ileocecal valve becomes the intussusception head, carrying the end of the ileum into the ascending colon, with the cecum and part of the appendix being brought into the colon.
Doesn’t this situation sound troublesome even just thinking about it?
Under fluoroscopy, the gas injected reaches the diagnostic area of the sheath. The gas entering the inner, outer, and middle tubes can present a cup-shaped image, a characteristic X-ray feature of intussusception. If too much has flipped inside, the gas will diffuse and mix in the chaotic mass of intestinal tubes, looking like a light cluster overall, making it difficult to differentiate layers.
Doctor Yang is now observing the state of the child’s intestinal tubes under the fluoroscopy; it doesn’t appear to be the initial cup-shape or clamp-shape.
Clamp-shape, as the name might suggest, the structure of intussuscepted intestinal tubes and cup-shape is relatively clearer in layers, possibly indicating a deeper intussusception resembling a pair of clamps.