How to show up laparoscopically?

One day in mid-May, a distant guest came to the office of Li Hucheng, director of the Hepatobiliary Department of the Transplantation Institute, who told him that she had a “baby” hidden in her abdomen. The patient was an elderly woman who was unable to determine the cause of her recurrent black stools, so she underwent capsule endoscopy at a local hospital in hopes of clarifying the cause. Unexpectedly, the capsule endoscope worth thousands of dollars was not moved after eating. The local doctors used all kinds of methods, including colonoscopy, diarrhea, Chinese medicine, etc., for 100 days, but this “baby” is still not moving. This can be a great deal of anxiety Zhao Ma and local doctors, capsule endoscopy not only did not check the problem, long-term stay in the stomach and the possibility of inflammation, perforation. In the end, she came all the way to Beijing 309 Hospital, hoping to get the “baby” out of her stomach through minimally invasive technology. Director Li Hucheng carefully studied the local CT and X-rays and concluded that the capsule endoscope was located in the intestinal tract in the pelvic cavity and should be within 100 cm of the end of the small intestine. There are two possible reasons for the capsule endoscope being stuck in the intestine: one is that the small intestine is occupied and narrowed, causing the capsule endoscope not to pass through; the other possibility is Meckel’s diverticulum, where the capsule endoscope enters the diverticulum like a car falling into a trap, and can no longer peristaltic down the normal intestine, but stays in the intestine. The only way to solve this problem is to determine the exact location of the capsule endoscope, cut open the small intestine, remove the capsule endoscope, and if a tumor or Meckel’s diverticulum is found at the same time, partial small bowel resection or Meckel’s diverticulum resection can be performed at the same time. However, the crux of the problem is how to determine the exact location of the capsule endoscope. There is no similar report in the literature and no experience to be learned from. The whole department worked together and decided to perform a three-hole laparoscopic minimally invasive technique to find the “baby” from the ileocecal region upwards under X-ray surveillance. Director Li Hucheng led Huang Hui, Wang Ruiguan, Wu Tiantian, Zhang Wei and Jia Baolei, and with the close cooperation of Director Liu Xiuzhen of the Department of Anesthesiology, he again went into battle. First, a 1.0-cm incision was made below the umbilical fossa and a laparoscope was placed, then a 1.0-cm Trocar was placed at the Mai’s point as the main operation hole under direct laparoscopic view, and a 0.5-cm Trocar was placed at the anti-Mai’s point in the left lower abdomen, and a comprehensive exploration of the abdominal cavity revealed no obvious abnormalities. According to the preoperative plan, they first found the appendix and the ileocecal region, and with this as the marker, the operator and the assistant worked closely together, and gradually explored the intestinal canal retrogradely upward, 2 cm at a time. When the exploration reached about 100 cm from the ileocecal region, the intestinal forceps held tightly by Director Li Hucheng’s right hand felt the abnormality, and he felt the presence of the capsule endoscope through the small intestinal wall, just like a sapper detecting a mine. The assistant used intestinal forceps at the upper and lower end of the capsule endoscope to block the intestine and prevent the capsule endoscope from slipping away again. Here, the intestinal wall was cut and Director Li Hucheng used foreign body forceps to steadily remove the capsule endoscope from the abdominal cavity, so that the “baby” that had been hidden in the abdomen for 100 days finally saw the light of day. They continued to explore and found that there was a “tunnel”, or Meckel’s diverticulum, about 4cm x 3cm in size, with significant inflammation, edema, and adhesions to the mesentery. This was the underlying cause of recurrent blood in the stool and retention of the capsule endoscope. They removed the Meckel’s diverticulum with 10 cm of small intestine and performed an end-to-end anastomosis. The operation went smoothly and lasted 1 hour and 10 minutes, and he was out on the floor the same day after the operation. The patient was discharged from the hospital 7 days after surgery without incision or abdominal infection and returned to normal life. The Third Department of Hepatobiliary Surgery has always been characterized by daring to challenge and pioneering in carrying out new technologies, new businesses and internal construction. They dare to do what others dare not do and dare to do what others cannot do, and it is because of this enterprising spirit of going forward that the endoscopic technology of the Third Department of Hepatobiliary Surgery has been continuously improved and innovated to benefit more patients.