Gallagher Kara Lee
Department of Cabarrus Family Medicine, Carolinas Medical Center-Northeast, Concord, North Carolina, USA.
BMJ Case Rep. 2013 Jul 26;2013:bcr2013008939. doi: 10.1136/bcr-2013-008939.
An 81-year-old man with a medical history significant for diverticulosis and irritable bowel syndrome presented to the emergency department with a 1-day history of periumbilical pain that woke him from sleep and ultimately localised to his right lower quadrant. He reported nausea, anorexia and chills but denied vomiting, diarrhoea, melena, hematochezia or fever. His physical exam was notable for focal tenderness at McBurney's point. Diagnostic information included a normal white blood cell count and an abdominal CT scan that demonstrated a normal appendix with no other pathology noted. The patient opted to proceed with laparoscopy where a normal appendix was found. The caecum, however, contained a large ischaemic diverticulum not noted on CT scan. Following laparoscopic ileocecectomy, pathology demonstrated haemorrhage, inflammation, oedema and full thickness necrosis of the caecal wall. Recovery was uneventful; the patient was discharged from the hospital 3 days following surgery.
一名81岁男性，有憩室病和肠易激综合征病史，因脐周疼痛1天就诊于急诊科。疼痛使他从睡眠中醒来，最终转移至右下腹。他自述有恶心、厌食和寒战，但否认呕吐、腹泻、黑便、便血或发热。体格检查发现麦氏点有压痛。诊断信息包括白细胞计数正常，腹部CT扫描显示阑尾正常，未发现其他病变。患者选择进行腹腔镜检查，结果发现阑尾正常。然而，盲肠中有一个大的缺血性憩室，CT扫描未发现。腹腔镜下进行回盲部切除术后，病理显示盲肠壁有出血、炎症、水肿和全层坏死。恢复过程顺利；患者术后3天出院。
