Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, San Donato Milanese, Milano, Italy.
Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, San Donato Milanese, Milano, Italy ; Department of Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Milano, Italy.
World J Emerg Surg. 2014 Dec 19;9(1):63. doi: 10.1186/1749-7922-9-63. eCollection 2014.
Diverticulitis and carcinoma represent the most common causes of colon perforation, but other causes, like ingestion of foreign bodies, should be taken into account.
We report the case of a 64-year old man presenting in our Emergency Department with a 2 days history of right lower abdominal pain, nausea, vomiting and low grade fever. Physical examination evocated mild pain with positive rebound tenderness in the right lower abdominal quadrant, and positive right costovertebral angle tenderness. Routine blood tests, abdominal X-rays and CT scan were inconclusive for perforation. At explorative laparoscopy a cecal perforation with localized peritonitis was found, and a right colectomy was performed due to the suspicion of cancer. Histological examination confirmed the presence of a perforation caused by a piece of wood (toothpick) of 6 cm in length.
Foreign body ingestion should be taken into account in the evaluation of acute abdominal pain. A detailed patient's history may be crucial for a correct diagnosis and treatment.
憩室炎和癌是导致结肠穿孔的最常见原因，但也应考虑其他原因，如异物摄入。
我们报告了一例 64 岁男性患者的病例，他因右下腹痛、恶心、呕吐和低热就诊于我院急诊科。体格检查提示右下腹象限有轻度疼痛，伴有阳性反跳痛，右侧肋脊角压痛。常规血液检查、腹部 X 线和 CT 扫描均不能明确穿孔。在腹腔镜探查时发现盲肠穿孔伴局限性腹膜炎，由于怀疑癌症，进行了右结肠切除术。组织学检查证实穿孔是由长 6 厘米的一块木头（牙签）引起的。
在评估急性腹痛时，应考虑异物摄入。详细的病史对正确诊断和治疗至关重要。
