Eze Kenneth C, Salami Taofeek A, Kpolugbo James U
Department of Radiology, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria.
Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria.
Niger Med J. 2014 May;55(3):195-200. doi: 10.4103/0300-1652.132037.
To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions.
A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed.
Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis.
Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission.
强调拉沙热患者急腹症的诊断和管理问题。同时强调对于出现急性腹痛的患者，需要高度怀疑拉沙热，以避免进行预后不良的手术干预以及医院内感染传播，特别是在拉沙热流行地区。
回顾作者在4年期间（2004 - 2008年）管理拉沙热的经验。2010年11月研究并回顾了互联网及其他当地来源的有关拉沙热的文献。
由于肺水肿、肺出血和急性呼吸窘迫综合征，正常的胸部平片影像可能迅速改变。腹部平片可能显示肠扩张，伴有麻痹性肠梗阻体征或因肠壁出血或发炎及肿大的派伊尔氏淋巴集结而导致的动力性肠梗阻。超声检查可能显示因腹膜炎和腹腔内出血导致的腹腔内游离液体。胆囊壁出血可能错误地提示感染性胆囊炎。使用超声心动图可能会发现伴有或不伴有引起腹痛的心包炎的心包积液。高度怀疑、进行拉沙热抗体检测以及在参考实验室进行病毒分离对于准确诊断至关重要。
来自拉沙热流行地区的患者可能表现出提示急腹症的特征。影像学研究可能显示提示急腹症的结果，但这些结果应结合患者的总体临床状况进行解读。必须认识到，在拉沙热流行地区，急性腹痛和呕吐可能由拉沙热引起，这是一种医学病症。应谨慎选择手术方案，因为手术会增加发病率，可能使预后恶化并增加医院内传播的风险。
