Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan.
Intern Med. 2023 Nov 15;62(22):3327-3331. doi: 10.2169/internalmedicine.1211-22. Epub 2023 Mar 22.
A 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white blood cell count of 5,300 cells/μL and C-reactive protein level of 0.07 mg/dL. Inflammation and anemia (hemoglobin 12.4 g/dL) were denied. Contrast-enhanced computed tomography (CT) revealed multiple duodenal diverticula and air surrounding a descending duodenal diverticulum. Based on these findings, duodenal diverticular perforation (DDP) was suspected. Oral food intake was stopped, and nasogastric tube feeding and conservative treatment with cefmetazole, lansoprazole, and ulinastatin were begun. On day 8 of hospitalization, follow-up CT revealed the disappearance of the air surrounding the duodenum, and the patient was discharged on day 19 after the resumption of oral feeding.
一位 59 岁女性以黑便为主诉就诊。她无腹部发现，如压痛或敲击痛。实验室检查显示白细胞计数为 5300 个/μL，C-反应蛋白水平为 0.07mg/dL。否认有炎症和贫血（血红蛋白 12.4g/dL）。增强 CT 显示多个十二指肠憩室和围绕降段十二指肠憩室的空气。根据这些发现，怀疑为十二指肠憩室穿孔（DDP）。停止口服进食，进行鼻胃管喂养，并开始使用头孢美唑、兰索拉唑和乌司他丁进行保守治疗。住院第 8 天，随访 CT 显示十二指肠周围的空气消失，患者在恢复口服喂养后第 19 天出院。
