Bannura G, Melo C, Villamán J, Muñoz M, Levy I
Servicio y Departamento de Cirugía, Hospital Clínico San Borja Arriaran, Facultad de Medicina, Universidad de Chile.
Rev Med Chil. 1999 May;127(5):595-9.
We report a 65 years old female undergoing hemodialysis, presenting with intense pain in the lower right quadrant and moderate hematochezia. Since symptoms did not abate after an appendectomy, a colonoscopy and barium enema were performed, whose results suggested an advanced cecal carcinoma. Biopsies were negative for cancer. A new surgical abdominal exploration disclosed a cecal inflammatory and transmural lesion. A right colectomy was performed and the patient had a satisfactory postoperative evolution. Pathological study of the surgical piece showed a six cm perforated profound ulceration and a two cm ulcer. Both had precise limits. Unspecific cecal ulcers are rare entities that must be born in mind in the differential diagnosis of abdominal pain or hematochezia, specially in patients undergoing chronic hemodialysis.
我们报告一例65岁接受血液透析的女性,表现为右下腹剧痛和中度便血。阑尾切除术后症状未减轻,遂进行结肠镜检查和钡灌肠,结果提示盲肠晚期癌。活检未发现癌细胞。再次进行腹部手术探查发现盲肠有炎症性透壁病变。行右半结肠切除术,患者术后恢复良好。手术标本的病理研究显示有一个6厘米的穿孔性深部溃疡和一个2厘米的溃疡。两者边界清晰。非特异性盲肠溃疡是罕见的疾病,在腹痛或便血的鉴别诊断中必须考虑到,特别是在慢性血液透析患者中。