Nkwam N, Desai A, Radley S
Colorectal Surgery, Queen Elizabeth Hospital, Birmingham, West Midlands, UK.
BMJ Case Rep. 2010 Nov 19;2010:bcr0520103050. doi: 10.1136/bcr.05.2010.3050.
This 67-year-old woman, with numerous previous abdominal operations, presented to her general practitioner 3 years ago with generalised abdominal pain and diarrhoea. With unremarkable haematology tests and a CT scan at that time she was given the diagnosis of irritable bowel syndrome. During the next 3 years her symptoms continued intermittently and now associated with vomiting and weight loss. This time both a barium follow-through followed by a CT scan demonstrated a small bowel intussusception. A laparotomy was done but surprisingly no intussusception was found, only a single adhesional band which was divided. She was discharged 5-days postoperative but re-admitted 3 days later with abdominal discomfort, bloating and vomiting. A repeat CT scan again showed the presence of a small bowel intussusception and a second laparotomy was performed, this time demonstrating a jejuno-ileal intussusception which was reduced and resected with primary anastomosis. Her postoperative course was without incidents.
这位67岁的女性既往接受过多次腹部手术，3年前因全腹疼痛和腹泻就诊于她的全科医生。当时血液学检查无异常，CT扫描显示她被诊断为肠易激综合征。在接下来的3年里，她的症状间歇性持续，现在还伴有呕吐和体重减轻。这次钡剂灌肠造影后行CT扫描显示小肠套叠。进行了剖腹探查术，但令人惊讶的是未发现套叠，仅发现一条粘连带并将其分离。术后5天她出院了，但3天后因腹部不适、腹胀和呕吐再次入院。再次进行CT扫描显示小肠套叠仍然存在，于是进行了第二次剖腹探查术，这次发现是空肠-回肠套叠，予以复位并切除，同时进行了一期吻合。她的术后恢复过程顺利。
