一名21三体综合征患者自发性特发性大网膜梗死的疑难病例。
A challenging case of spontaneous idiopathic omental infarction in a trisomy 21 patient.
作者信息
Roy Aaron, Mah Jin-Jiun, Ambikapathi Theiyallen, Mra Aung, Hayati Firdaus
机构信息
Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.
Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
出版信息
Ann Med Surg (Lond). 2022 May 13;78:103760. doi: 10.1016/j.amsu.2022.103760. eCollection 2022 Jun.
BACKGROUND
Omental infarction (OI) is a rare cause of acute abdominal pain that is often missed out. Due to its non-specific presentation can mimic other commoner conditions such as acute appendicitis, acute diverticulitis, and tuberculosis abdomen.
CASE PRESENTATION
We present a 42-year-old gentleman with trisomy 21 presenting right iliac fossa pain. Examination revealed tenderness in the right lower quadrant and blood parameters showed leucocytosis. With an initial impression of acute appendicitis, the patient was subjected to surgery. Intraoperatively, there were abnormalities to the omentum suggestive of OI, resulting in partial omentectomy. Symptom resolution occurred immediately and the patient was discharged early.
CONCLUSION
OI is a rare cause of acute abdomen that can mimic other abdominal pathologies. In trisomy 21 patients who present with acute abdomen, thorough assessments including preoperative imaging are advisable. Diagnostic laparoscopy is recommended as OI can be managed via minimally invasive surgery, hence ensuring good surgical outcomes.
背景
大网膜梗死（OI）是急性腹痛的罕见原因，常被漏诊。由于其表现不具特异性，可类似于其他较常见的病症，如急性阑尾炎、急性憩室炎和结核性腹膜炎。
病例报告
我们报告一名42岁的21三体综合征男性患者，出现右下腹疼痛。检查发现右下腹压痛，血液检查显示白细胞增多。初步诊断为急性阑尾炎，患者接受了手术。术中发现大网膜有异常，提示为大网膜梗死，遂行部分大网膜切除术。症状立即缓解，患者提前出院。
结论
大网膜梗死是急性腹痛的罕见原因，可类似于其他腹部病变。对于出现急性腹痛的21三体综合征患者，建议进行包括术前影像学检查在内的全面评估。由于大网膜梗死可通过微创手术治疗，故推荐诊断性腹腔镜检查，以确保良好的手术效果。
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