Chapter 2333 【2333】Weighing Gains and Losses
It is relatively safe to reset intussusception with air enema, and the commonly used techniques are widely used clinically and are very mature, but it has a time requirement for the patient's condition. For example, how many hours should emergency treatment be done for myocardial infarction, otherwise the effect will be greatly reduced or even invalid.
Specifically, clinical cases have been counted. The data show that this method has the highest success rate within 24 hours of the onset of the child's attack, which can reach more than 90%. More than 24 hours, there is a certain effect within 48 hours. After more than 48 hours, the folded part of the intestine is almost necrotic, and it is basically useless to inflate it at this moment, so surgery is required. So she, Xie Wanying, said that she must hurry up and seize the last window within 48 hours.
The problem is that your time is close to 48 hours. The probability of intestinal necrosis is high, and the success rate of air enema is low. It is a big risk to try to do this for children.
That's not to say air enemas are without danger. The most dangerous part of air enema is also known. It is like inflating the rubber. If the drum cannot be inflated, the only way to increase the air pressure is to increase the pressure. After the pressure is increased, the tube may burst in the lumen. Necrotic intestines are hard to beat and have a greater chance of bursting the intestines. Exploding intestines in the human body is intestinal perforation and hemorrhage in the abdominal cavity.
Well, the doctor knows about this horrific complication, so how about turning the pressure down a notch. There is also a tricky complication waiting for you, or intussusception.
This statement, 80% of laymen find it incredible: you use this method to solve intussusception, how can it cause intussusception?
Intestines are far more complicated than rubber tubing. The rubber tube has only one skin and is flat, the intestines are not.
Divided by branch histology in anatomy, the structure of the intestine can be divided into mucosal layer, muscular layer, serosa. The most complicated mucosal layer has a ring-shaped wrinkled wall structure. Simply put, it is called wrinkled, which is a normal physiological phenomenon.
The wrinkled wall of the intestinal mucosa is a physiological structure naturally evolved by the human body to retain the time for food to pass through the intestinal tract. The purpose is to allow the intestinal tract to absorb the nutrients of food well.
You think, if the food slides through the smooth rubber tube, and the food liquid passes through the intestines too quickly, how does the human body absorb these food nutrients, and it is difficult to absorb water.
When examining the digestive tract clinically, if you pay attention to some inspection reports, you can see the doctor's description of the intestinal folds. If there is a problem with the annular fold wall, it means that part of the cause of the patient's indigestion is here.
Due to the special physiological structure of the intestines, if the intussusceptible intestines are pushed back after pumping air into the intestines, it may cause dysfunction of other intestinal segments and cause intussusception in other parts. Who makes the wrinkled walls of the intestines a lot is another potential factor that causes intussusception.
In a word, as long as the probability of intestinal necrosis is high, and it cannot be moved by pumping, let alone cured, there will be many complications. The probability of intestinal necrosis is directly proportional to the time of onset in children.
From this point of view, the success rate of this child's air enema is not very high, and the doctor must focus on complications. I am not a specialist in pediatric general surgery, and I have few cases handled, so I have no experience in handling such cases. Knowing that there is such a solution, I am not sure that the problems that arise during the treatment can be solved, so I have to choose to give up.
It is safer to do nothing than to risk the life of the child. If it is done, complications may be counted as medical malpractice. The doctor would never dare to take such a risk.