Linn J J, Yen C C, Wang P H, Yen M S, Chao K C, Yuan C C, Ng H T
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Mar;63(3):247-50.
Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.
急腹症对一线医生来说是一项挑战，因为其诊断常常被漏诊，且可能引发后续法律问题。改善对这些患者的管理至关重要，这不仅关乎挽救生命，还能减少因管理不当而产生的不良问题。我们呈现一例因卵巢肿瘤破裂导致腹腔内出血而引发急腹症的患者病例。急诊手术后，该患者被诊断为转移性卵巢癌。由于胃肠道准备不当，患者因结肠癌接受了再次剖腹探查术。尽管这种情况在本病例中未影响患者的预后，但我们担心患者未能从一次手术中获益，此次手术本应是肿瘤的一期完整切除加结肠造口术。如果初始手术能实现最佳肿瘤细胞减灭，盆腔恶性肿瘤患者，尤其是卵巢癌患者的预后可能会更好。这通过良好的术前规划和准备是可行的。尽管急需治疗，我们仍强调术前准备的重要性。此外，每位一线医生都应告知患者及其家属恶性肿瘤的可能性。
