General Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
General Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.
BMJ Case Rep. 2020 Nov 4;13(11):e236429. doi: 10.1136/bcr-2020-236429.
A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.
一位 13 岁女孩因右髂窝转移性疼痛 3 天就诊。观察和炎症标志物均正常，超声检查结果不确定。初步诊断为非特异性腹痛或早期阑尾炎，并给予安全网建议后出院。6 天后，她再次出现腹痛，且伴有多次呕吐；因此，决定进行诊断性腹腔镜检查，而不是磁共振扫描以进一步评估。术中发现盆腔中有 200 毫升浆液性液体，阑尾外观正常，胃扩张和小肠环的纠结。钝性和小心的解剖显示出使腹腔镜器械磁化的瘘管。进行了小剖腹手术，取出 14 颗磁珠并修复 9 处肠穿孔。本例强调了在病因不明的急性腹痛患儿中仔细询问病史的重要性。
