Ohtsuka Yasuhiro, Tsuchiya Shin, Shida Takashi, Komatsu Teisuke
Department of General and Emergency Medicine Funabashi Central Hospital of Japan Community Health Care Organization Funabashi Japan.
Department of Internal Medicine Funabashi Central Hospital of Japan Community Health Care Organization Funabashi Japan.
Acute Med Surg. 2014 Nov 21;2(3):207-210. doi: 10.1002/ams2.94. eCollection 2015 Jul.
An 81-year-old woman was diagnosed with sigmoid volvulus. As there were no signs of peritoneal irritation, emergency endoscopic reduction was attempted and achieved successfully. Although she remained stable on the following day, she suddenly developed perforative pan-peritonitis 35 h after the procedure.
Emergency laparotomy revealed a 10-mm-diameter perforation at the anti-mesenteric wall of the top of the sigmoid loop, and sigmoid resection with Hartmann's procedure was carried out. Pathological examination revealed ischemic necrosis around the perforation site. She recovered well with intensive care, and was discharged 32 days later.
Delayed sigmoid perforation after endoscopic reduction of sigmoid volvulus is a rare but important and life-threatening pitfall, and should always be considered by acute care physicians. To prevent this dangerous complication, evaluation of the viability of the entire sigmoid by direct vision and semi-emergency operation as soon as the patient's condition is optimized after endoscopic reduction may be essential.
一名81岁女性被诊断为乙状结肠扭转。由于没有腹膜刺激征，尝试进行急诊内镜复位并成功完成。尽管她在术后第二天情况稳定，但在手术后35小时突然发生了穿孔性全腹膜炎。
急诊剖腹探查发现乙状结肠袢顶部系膜对侧肠壁有一个直径10毫米的穿孔，遂行乙状结肠切除并Hartmann手术。病理检查显示穿孔部位周围存在缺血性坏死。经过重症监护，她恢复良好，并于32天后出院。
乙状结肠扭转内镜复位术后迟发性乙状结肠穿孔是一种罕见但重要且危及生命的陷阱，急性护理医生应始终予以考虑。为预防这种危险的并发症，在内镜复位后一旦患者病情稳定，通过直视评估整个乙状结肠的活力并尽早进行半急诊手术可能至关重要。
