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罕见的左上腹痛病因。

Rare Cause of Left Upper Abdominal Pain.

机构信息

Grantham and District Hospital, Grantham, United Kingdom.

出版信息

Prague Med Rep. 2021;122(2):106-111. doi: 10.14712/23362936.2021.11.

Abstract

Inflamed diverticular disease of the small bowel is an uncommon cause of acute abdominal pain. Despite its low prevalence rate (0.3-2%), it is associated with a high mortality rate between 20-25% (Fisher and Fortin, 1977; Ferreira-Aparicio et al., 2012). This is due to complications including perforation, bleeding, and obstruction. This case report presents the diagnosis and management of Mr. X, a 70-year-old male with jejunal diverticulitis and a duodenal diverticulum. Mr. X has a background of type 2 diabetes mellitus and sigmoid diverticulosis, he presented with a three-day history of left upper quadrant pain radiating to the left iliac fossa. He was haemodynamically stable despite his elevated inflammatory markers (C-reactive protein 161 mg/l and neutrophils 13.3×109/l) and computerised tomography (CT) of the abdomen and pelvis showing jejunal diverticulitis and a duodenal diverticulum. Mr. X was successfully treated with intravenous antibiotics and analgesia and a follow up CT scan showed that the jejunal diverticulitis had resolved. Previous operative management of the discussed pathology has been reported, the current report is novel as the diagnosis was made early and the case managed conservatively.

摘要

空肠憩室炎是一种不常见的急性腹痛病因。尽管其发病率较低(0.3-2%),但死亡率却高达 20-25%(Fisher 和 Fortin,1977;Ferreira-Aparicio 等人,2012)。这是由于穿孔、出血和梗阻等并发症所致。本病例报告介绍了一位 70 岁男性患者(X 先生)的诊断和治疗经过,他患有空肠憩室炎和十二指肠憩室。X 先生有 2 型糖尿病和乙状结肠憩室病的病史,他因左上腹痛 3 天就诊,疼痛向左髂窝放射。尽管炎症标志物(C 反应蛋白 161mg/L 和中性粒细胞 13.3×109/L)升高,腹部和骨盆计算机断层扫描(CT)显示空肠憩室炎和十二指肠憩室,但他的血流动力学稳定。X 先生经静脉使用抗生素和镇痛治疗后病情得到缓解,随后的 CT 扫描显示空肠憩室炎已消退。已报道过该讨论病理的手术治疗方法,本报告是新颖的,因为早期诊断并保守治疗了该病例。

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