Mbarushimana Simon, Morris-Stiff Gareth, Thomas George
Cardiothoracic Surgery, Belfast, UK.
Department of General Surgery, Western Trust, Derry, UK.
BMJ Case Rep. 2014 Jun 27;2014:bcr2014204716. doi: 10.1136/bcr-2014-204716.
A 12-year-old boy was referred to the surgical unit with 4 h history of severe lower abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant medical or family history. Examination revealed tenderness in the lower abdomen, in particular the left iliac fossa. His white cell count was elevated at 19.6×10(9)/L, with a predominant neutrophilia of 15.8×10(9)/L and a C reactive protein of <0.3 mg/L. An abdominal X-ray revealed intraperitoneal gas and a chest X-ray identified free air under both hemidiaphragms. Subsequent diagnostic laparoscopy identified a perforated duodenal ulcer that was repaired by means of an omental patch. The case illustrates that although uncommon, alternate diagnoses must be borne in mind in children presenting with lower abdominal pain and diagnostic laparoscopy is a useful tool in children with visceral perforation as it avoids treatment delays and exposure to excess radiation.
一名12岁男孩因严重下腹痛和胆汁性呕吐4小时被转诊至外科病房。未报告其他症状，也无明显的病史或家族史。检查发现下腹部压痛，尤其是左下腹。他的白细胞计数升高至19.6×10⁹/L，以中性粒细胞增多为主，为15.8×10⁹/L，C反应蛋白<0.3mg/L。腹部X线显示腹腔内有气体，胸部X线显示双侧膈下有游离气体。随后的诊断性腹腔镜检查发现十二指肠溃疡穿孔，通过网膜补片进行了修复。该病例表明，尽管罕见，但对于出现下腹痛的儿童必须考虑其他诊断，诊断性腹腔镜检查是诊断内脏穿孔儿童的有用工具，因为它避免了治疗延迟和过度辐射暴露。
