Sağlam Fazıl, Sivrikoz Emre, Alemdar Ali, Kamalı Sedat, Arslan Ufuk, Güven Hakan
Department of General Surgery, Okmeydanı Training and Research Hospital, İstanbul, Turkey.
Ulus Travma Acil Cerrahi Derg. 2015 Mar;21(2):157-9. doi: 10.5505/tjtes.2015.62558.
The patient presented in this study was a 54-year-old woman complaining of nausea and vomiting, onset preceding four days, with no significant past medical history and an unremarkable surgical history. The patient was afebrile and hypertensive. Physical examination revealed a non-tender abdomen, and initial laboratory evaluation revealed elevated blood glucose level, ketonuria, leukocytosis, elevated C-reactive protein, gamma glutamyl transferase, lactate dehydrogenase, and total bilirubin. The patient was admitted to the internal medicine ward due to new onset of diabetes mellitus. Due to persistent nausea and vomiting, gastroscopy revealed a healed duodenal ulcer, and abdominal ultrasonography revealed cholelithiasis. The medical condition of the patient deteriorated further in the internal medicine ward, with impending hypotension, tachycardia, leukocytosis, and acute renal failure, and she was admitted to the intensive care unit due to septic shock. A computerized tomography was obtained, which revealed an impacted gallstone in the distal duodenum. The patient was taken to the operating room. The gallstone was encountered in proximal jejunum immediately distal to the ligament of Treitz. A longitudinal enterotomy was made, and the stone was extracted. Her drains were cleared on postoperative day 5, and gastrointestinal function returned to normal. Unfortunately, the patient developed an overwhelming sepsis due to bacteremia and fungemia, and died on post-operative day 19.
本研究中的患者为一名54岁女性，主诉恶心和呕吐，发病于四天前，既往无重大病史，手术史无异常。患者无发热，有高血压。体格检查显示腹部无压痛，初步实验室检查显示血糖水平升高、酮尿、白细胞增多、C反应蛋白、γ-谷氨酰转移酶、乳酸脱氢酶和总胆红素升高。患者因新发糖尿病入住内科病房。由于持续恶心和呕吐，胃镜检查显示十二指肠溃疡已愈合，腹部超声检查显示有胆结石。患者在内科病房的病情进一步恶化，出现低血压、心动过速、白细胞增多和急性肾衰竭，因感染性休克转入重症监护病房。进行了计算机断层扫描，显示十二指肠远端有一枚嵌顿性胆结石。患者被送往手术室。在Treitz韧带远端的近端空肠发现了胆结石。做了纵向肠切开术，取出了结石。术后第5天引流管通畅，胃肠功能恢复正常。不幸的是，患者因菌血症和真菌血症发展为严重脓毒症，于术后第19天死亡。
