Hanna Thomas, Powys-Lybbe James, Akoh Jacob A
Department of Surgery, Derriford Hospital, Plymouth, UK.
Clin Pract. 2011 Apr 15;1(1):e19. doi: 10.4081/cp.2011.e19. eCollection 2011 Mar 29.
Bowel infarction due to acute mesenteric ischaemia (AMI) is an abdominal emergency with a high mortality rate. We report a case of exaggerated septic response to a urinary tract infection mimicking AMI in an immunosuppressed diabetic patient. A 56-year-old female was found collapsed at home with a 24 hour history of diarrhoea, a central abdominal pain and a complex past medical history. Examination showed her to be pyrexial, drowsy, profoundly dehydrated with evidence of cardiovascular collapse. She had a tender distended abdomen, raised inflammatory markers, raised lactate of 9.1 u/L and urinalysis was positive for leucocytes and nitrites. An abdominal computed tomography (CT) scan was reported to show small bowel ischaemia. She underwent a negative laparotomy and recovered following management in the intensive therapy unit. The negative laparotomy rate can be reduced by having abdominal CT performed and reported by an experienced radiologist or by the use of diagnostic laparoscopy.
急性肠系膜缺血（AMI）所致的肠梗死是一种死亡率很高的腹部急症。我们报告一例免疫抑制的糖尿病患者，对模拟AMI的尿路感染出现过度脓毒症反应的病例。一名56岁女性在家中晕倒，有24小时腹泻、中腹部疼痛病史及复杂的既往病史。检查发现她发热、嗜睡、严重脱水，有心血管衰竭迹象。她腹部膨隆且有压痛，炎症标志物升高，乳酸水平升至9.1 u/L，尿液分析白细胞和亚硝酸盐呈阳性。腹部计算机断层扫描（CT）报告显示小肠缺血。她接受了阴性剖腹探查术，在重症监护病房治疗后康复。通过由经验丰富的放射科医生进行并报告腹部CT或使用诊断性腹腔镜检查，可以降低阴性剖腹探查率。
