During the physical examination, I reviewed the relevant tests already available for the patient and diagnosed acute appendicitis. I just wanted to wrap this up quickly; with a bit of luck, I might even be able to go home and sleep before noon. But little did I expect that the family would be so anxious it was as if their house was on fire, constantly urging me, which made me extremely irritated. Finally, I could no longer contain myself and yelled at the family member who had repeatedly urged me: "Can't you see that I've been busy with your child? Every minute you waste is another minute delaying your child's surgery! Go back and watch over your child, don't follow me around!" Do you think this is like going to a noodle shop to eat noodles? There are a lot of preoperative examinations required: the first ultrasound, major medical records, preoperative summary, surgical consent form, admission communication record, preoperative communication record, preoperative orders... Not to mention contacting the operating room and the anesthesiologist, and also checking whether the emergency room is occupied. Of course, all these things I could only mutter in my mind; there was no time to explain these extra details to the family.
To prevent choking or aspiration pneumonia due to vomiting during anesthesia or surgery, there are strict requirements for fasting and water deprivation for surgical patients. This child met the criteria, so I just wanted to complete the preoperative preparations as soon as possible. Even when everyone started handing over shifts, I was still sitting in front of the computer furiously writing orders (all personnel are required to stand during shift handovers in our department, but everyone understood my urgency to get to the surgery and didn't take offense). By the time the necessary preoperative test results were out and the anesthesiologist had finished examining the patient, it was already past 9 o'clock. During this period, I also had to finish rounds and handle the original hospitalized patients under my responsibility.
By the time we entered the operating room, it was already 10 o'clock. I washed my hands, disinfected, put on the surgical gown, went up to the operating table, and the anesthesiologist had completed the anesthesia. Before making the incision, I once again reviewed the condition of this child: abdominal pain for one day, fixed tenderness in the right lower abdomen, white blood cell count of 17,000, which was already quite typical for appendicitis. The only slightly strange thing was that although there was fixed tenderness in the right lower abdomen, there was no muscle tension or rebound tenderness, which should belong to the early stage of appendicitis, definitely no pus or perforation. So why was the child experiencing such severe pain? Hmm, maybe the child is usually too delicate and more sensitive to pain than others.
Thus, without hesitation, after disinfecting the local surgical area and testing the skin (using a hooked forceps to pinch the patient's belly skin to check the anesthetic effect), I made a McBurney incision to enter the abdominal cavity, swiftly removing the appendix. The appendix end was found to be congested and swollen, consistent with appendicitis, but this couldn't explain the severe pain experienced preoperatively. After removing the appendix, there was still a large amount of exudate in the abdominal cavity, transparent, light yellow, soaking several large gauze pads. The nurse asked: "Did you accidentally cut the bladder?" At that moment, I wanted to kick her. Classic surgical textbooks list dozens of differential diagnoses for appendicitis in this chapter, meaning that in some atypical cases, misdiagnosis may occur. But for this child, although the intraoperative findings supported the diagnosis of appendicitis, they could not explain the severe preoperative pain. Could there be something else wrong?