Ichinose Akinori, Ishibashi Yuji, Hatao Fumihiko, Morita Yasuhiro
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Ann Surg Treat Res. 2023 Apr;104(4):222-228. doi: 10.4174/astr.2023.104.4.222. Epub 2023 Mar 31.
The present study aimed to examine the characteristics, outcomes, and problems related to surgery for acute abdomen in adult patients with severe motor and intellectual disabilities (MID).
The clinical records of 35 adult patients with severe MID who received emergency surgery for acute abdomen between 2011 and 2020 were reviewed.
The median duration from onset to surgery was 48 hours. There were 2 cases of in-hospital mortality (5.7%), and all the patients underwent surgery more than 72 hours after onset. The in-hospital mortality rate was significantly higher in patients who received surgery later than 72 hours after onset. Bowel obstruction was the most common disease among the acute abdomen cases (71.4%) and most often involved volvulus of the small bowel and cecum. Of the patients with bowel obstruction with severe MID, 72.0% had abdominal distention, 16.0% had abdominal pain, and 4.0% had vomiting. The median duration from onset to surgery was significantly longer in the patients with bowel obstruction with severe MID than in those without severe MID (24 hours 16 hours).
Acute abdomen in patients with severe MID was often due to bowel obstruction caused by volvulus. Because patients with severe MID have few symptoms, they are susceptible to adverse surgical outcomes associated with a prolonged duration from onset to surgery.
本研究旨在探讨成年重度运动和智力障碍（MID）患者急性腹痛手术的特点、结局及相关问题。
回顾了2011年至2020年间35例接受急性腹痛急诊手术的成年重度MID患者的临床记录。
从发病到手术的中位时间为48小时。有2例住院死亡（5.7%），所有死亡患者均在发病72小时后接受手术。发病后72小时后接受手术的患者住院死亡率显著更高。肠梗阻是急性腹痛病例中最常见的疾病（71.4%），最常涉及小肠和盲肠扭转。在重度MID的肠梗阻患者中，72.0%有腹胀，16.0%有腹痛，4.0%有呕吐。重度MID的肠梗阻患者从发病到手术的中位时间显著长于无重度MID的患者（24小时对16小时）。
重度MID患者的急性腹痛常由扭转引起的肠梗阻所致。由于重度MID患者症状较少，他们易发生与发病到手术时间延长相关的不良手术结局。
