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鱼骨致十二指肠穿孔继发肝脓肿:病例报告

Liver abscess secondary to duodenal perforation by fishbone: Report of a case.

作者信息

Jimenez-Fuertes Montiel, Moreno-Posadas Ana, Ruíz-Tovar Polo Jaime, Durán-Poveda Manuel

机构信息

Cirugía Hepatobiliopancreática., Hospital Rey Juan Carlos, España.

Cirugía General y Digestiva, Hospital Rey Juan Carlos, España.

出版信息

Rev Esp Enferm Dig. 2016 Jan;108(1):42.

Abstract

Liver abscesses usually arise from amoebian or bacterial origin, being rarely secondary to foreign bodies (1-3). We report the case of a 72-years-old female complaining from abdominal pain located in epoigastrium and right hypochondrium during the last 48 hours. Laboratory data revealed leukocytosis with neutrophilia and pain located in the mentioned locations at physical examination. Ultrasonography showed a liver abscess involving segments 2 and 3. CT scan revealed that the abscess was secondary to a fishbone perforating the duodenum and inlaid in the liver (Figure 1). The fishbone was surgically extracted from the hepatic lobe with hemostasia and a duodenal suture with epiploplastia was performed. Antibiotic was added to the treatment. The patient presented an uneventful postoperative course. The intake of foreign bodies is a frequent event, representing bones and fishbones the most frequent foreing bodies in the adults. Sometimes, the diagnosis may be difficult because the symptoms are not specific. Imaging test are very usefol for the diagnosis, as in the case we present.

摘要

肝脓肿通常起源于阿米巴或细菌感染,很少继发于异物(1 - 3)。我们报告一例72岁女性病例,该患者在过去48小时内主诉上腹部和右季肋部疼痛。实验室检查数据显示白细胞增多伴中性粒细胞增多,体格检查时疼痛位于上述部位。超声检查显示肝脓肿累及第2和第3肝段。CT扫描显示脓肿继发于一根鱼刺穿透十二指肠并嵌入肝脏(图1)。通过手术从肝叶取出鱼刺并进行止血,同时进行十二指肠带网膜修补缝合。治疗中加用了抗生素。患者术后恢复顺利。摄入异物是常见事件,在成年人中骨头和鱼刺是最常见的异物。有时,诊断可能困难,因为症状不具特异性。影像学检查对诊断非常有用,就像我们所呈现的这个病例一样。

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