Acute Abdomen

"Name?"

"Gris."

"No, I mean the child's name. How old is she?" Kraft quickly filled in the name Gris in the family section, noting him as the patient's father.

They were sitting in an empty classroom. Lucius had been sent off to find two blankets, as the patient would inevitably be uncomfortable lying on the hard bench. The students who had followed were kept at bay, leaving enough space.

The paper in his hand had been torn from a stack of scribbling sheets, with the second volume of Human Anatomy placed underneath as a backing. A student nearby, quick on the uptake, handed him an ink bottle. The tip of his pen sketched rapidly across the paper, the characters stringing together.

Although Kraft's handwriting was actually quite good, his medical records always ended up looking crooked, as if influenced by some mysterious force.

"Lis, her name is Lis." Gris, somewhat intimidated, answered Kraft's questions quickly and in a low voice, as if he feared that if he were a moment too slow, Kraft would lose interest and walk away. "She is three years old this year."

The large group of black-robed figures put significant pressure on him. They had retreated a bit upon request, but they still made the bright classroom feel somewhat gloomy and ominous.

"Where is she uncomfortable?" Kraft asked, turning his head to glance at the child lying across the chairs. It was hard to tell the gender of a child at this age without being told. Thinking back, he had indeed seen this child at the tavern sometimes, but a set of nondescript clothes had led him to assume she was a boy.

When this topic came up, Gris looked like he was about to cry, his eyes rimmed with red, but he still restrained his emotions and described what he knew as clearly as possible.

"She seemed to have eaten something two days ago and has been having diarrhea ever since. I thought it would get better in a few days, but I didn't expect her stomach to hurt even more this morning—it hurt so much she could barely speak.

I took her to the church earlier to ask for some holy water, and I also went to a clinic and had her drink some herbal soup, but it was useless."

"What kind of herbs?" Kraft pressed. He knew about holy water; it was just water purified through some strange rituals. He had drunk it himself when he was a child, and as a placebo, it was at least harmless.

Herbs were another matter. Few doctors running clinics outside were graduates of the academy; all sorts of folk remedies and bizarre concoctions ran rampant, and they would add anything to their soups.

This wasn't like the systematic diagnosis and treatment of traditional medicine; the methods of the amateur doctors in Wenden Port were less like medicine for humans and more like the work of those green-skinned things that grew out of the ground—their main guiding principle was "I reckon."

"I'm sorry, I don't know..." Gris said, at a loss. "The priest said it was because I didn't believe in the Lord with all my heart, and that's why this happened. Should I not have let her drink those herbs?"

This middle-aged man clutched his head in agony, almost tearing out his own hair. In his eyes, this was the precursor to death; he was about to lose his only child.

"That's not what I meant." Kraft pressed down on his shoulder, trying to calm him. "It doesn't matter if you don't remember. I have other questions to ask you."

It had to be said that Gris was the type of parent doctors liked best. Despite his panic and fear over his daughter's condition, he was quite composed, allowing Kraft to quickly obtain relatively complete information.

The patient was Gris's three-year-old daughter, Lis, who had suddenly developed a fever and diarrhea two days ago, with stools as thin as water.

This wasn't particularly unusual; it was perfectly normal for a child of this age to get an upset stomach for no apparent reason, and most of the time, parents wouldn't pay much attention to it.

As a father who cared for his child, Gris had even taken the time to go to the church to pray and brought back some holy water for her.

But a day after drinking the holy water, little Lis's condition did not improve, so a worried Gris took her to a nearby clinic and had the doctor prescribe a bowl of herbal soup.

Looking at the soup, which was an abnormal color, Gris still intended to let Lis try it, but the attempt proved fatal. Early this morning, Lis's abdominal pain, which hadn't been severe, rapidly worsened, and the stool she passed, while small in amount, was tinged with blood.

An anxious Gris carried Lis to the church and the clinic, but the priest only indicated that this situation required devout prayer and waiting for God's will. The doctor at the clinic was even more helpless, only thinking about how to distance himself from the situation.

As someone who had run a tavern near the academy for a long time, the last resort Gris could think of was to seek help from people he knew at the academy; otherwise, he could only wait to see if Lis would miraculously recover on her own.

"I need to perform an examination, is that alright?" Kraft finished recording the history of the present illness and basic information on the paper. The past medical history and family history were only a few strokes; he only knew that Lis's mother had also died of an acute illness, though Gris couldn't say what it was. Lis herself hadn't had any major illnesses since birth.

"Yes, thank you." Gris nodded quickly. He didn't understand why he had to be asked for permission, but judging by Kraft's attitude, he seemed to be taking over the case.

"I mean a comprehensive examination. I need to touch the entire abdomen, including the groin area." Kraft glanced at the group of students behind him, feeling he should clarify first. "I don't think it's appropriate for too many people to watch. Gentlemen, could you step aside for a moment? You can take this time to review why I asked so many questions."

"Um... no problem." Gris hesitated but agreed, preparing to leave with the students. Perhaps it was Kraft's serious attitude that had earned his trust, as he didn't raise any questions.

"Gris, come back. I meant them. Family should stay to accompany and help soothe the child." The students quickly exited, and Kraft pulled Gris over to the child to begin the examination.

Kraft brushed aside her hair and touched Lis's forehead; the temperature wasn't high. The child's face was covered in tear tracks; she probably wasn't crying anymore because she had been crying for so long and was now too exhausted to continue.

He already had an idea in his mind. This kind of thing belonged to what was most often discussed in diagnostics—an Acute Abdomen, or in layman's terms, "Doctor, my stomach hurts." Even without his extraordinary memory, he could skillfully apply the content.

A three-year-old child with diarrhea and fever for two days—it should be a gastrointestinal infection caused by some pathogen, which was very common in Wenden Port, where seafood was everywhere.

But today's situation was likely not just an infection getting worse. The sudden decrease in bowel movements, combined with blood, was most likely an obstruction somewhere.

Kraft touched the abdominal wall, which looked perfectly normal, and felt no obvious tension or rigidity when pressing down.

This made him breathe a sigh of relief; it didn't seem to have reached the point of fluid exudation irritating the peritoneum, so perhaps it wasn't too serious.

Following a fixed direction, he quickly found evidence to support his view: a mass in the lower right abdomen that felt somewhat like a sausage.

The situation was manageable. Kraft's heart, which had been in his throat, finally settled. It should be an Intussusception, and in this location, he could boldly guess it was an Ileocecal Region intussusception.

At the junction of the small and large intestines, a segment of the ileum had telescoped into the large intestine, turning one layer into several, causing an immediate obstruction. This was not uncommon for children whose intestinal function was easily disrupted, and it was one of the most common acute abdominal conditions handled in pediatric surgery.

This poor child might have had viral diarrhea, which was a risk factor for intussusception, and then she drank some strange herbal soup, which naturally led to the intussusception.

The diagnostic process had gone quite smoothly, giving Kraft a feeling similar to answering a teacher's questions in a case study class—confidently providing the answer after finding all the evidence.

Normally, the next step would be imaging to confirm the diagnosis, but unfortunately, there was no ultrasound here, nor could he take an upright abdominal X-ray, so a one-hundred-percent confirmation was out of the question.

He covered the child back up, picked up his pen and paper, and added a "Preliminary Diagnosis" section at the bottom of the page. He combined the Norse Language words for "intestine" and "telescoping" and left a line of space underneath.

When he had time, he would have to add an explanation below it; ever since he became a lecturer, he had to leave space for definitions everywhere—it was becoming an occupational disease.

He looked up and explained to Gris, "You can understand it as a section of her intestine having telescoped into another, and then it got stuck. Do you remember when she started to hurt?"

"It was probably before the clock tower struck twice. I took her to the church once, but I don't remember the exact time."

That was probably between an hour and a half to two hours ago—the best of a bad situation. Because it was discovered in time, even with the detour to the church, it hadn't yet reached the point of intestinal necrosis, so it could be resolved with a non-surgical approach.

So, what was the non-surgical option again?

"No, that's not right..." Kraft muttered, his heart sinking as quickly as it had settled. It felt like being stuck on the final step of a complex calculus problem; everything seemed correct, but the calculation simply wouldn't resolve.

"What's not right?" Gris grew tense as well. Kraft had just explained the cause of the illness to him, and now things seemed to be getting complicated again. The last thing anyone wants in this situation is for the doctor to suddenly lose their smile.

Kraft didn't answer him. A grave problem lay before him, blocking the final path forward.

For the current situation, the standard answer he knew was an air enema, which could easily resolve most cases of early-stage acute intussusception like the one Lis had.

But that required specialized equipment. He hadn't studied mechanical engineering and had no idea how to control air pressure to push the intestine back into place while ensuring it didn't perforate.

Even if he knew how to build it, could he just conjure a machine out of thin air? And even if he took a step back and assumed the god of The Church performed a miracle to manifest the machine, how would he confirm the reduction was successful without ultrasound, X-rays, or other imaging diagnostics?

Since the air enema option was a dead end, only the traditional method remained: Kraft would have to perform surgery, forcing little Lis to go under the knife, using an invasive but more direct and effective method to fix the intestine.

But if an air enema wasn't feasible, could he really perform surgery under these conditions? Attempting surgery without anesthesia or a sterile environment would be even more hopeless than praying for an angel to deliver an air enema machine.