以不典型疼痛为首发症状的先天性腹内疝1例报告及文献复习

Congenital intrabdominal hernia with atypical pain as first manifestation: A case report and literature review

摘要

目的 探讨先天性腹内疝患者的临床特征、诊断过程和治疗方法，总结在诊治过程中可能出现的误区，旨在提高临床医生对该病的认识。 方法 收集1例先天性腹内疝患者的临床资料和辅助检查结果，分析上述资料并进行相关文献复习。 结果 患者，男性，65岁，2 d前因中上腹疼痛就诊于当地医院，于当地医院检查未见明显异常，血糖>25 mmol·L^－1，予以降糖、补液和血液净化治疗后，患者病情加重，出现意识不清、血压下降和呼吸困难，为求进一步诊治于本院就诊。入院后予以液体复苏、机械通气和支持治疗后，患者症状未见好转，由介入科行腹腔动脉和右侧股静脉造影，未见明显腹部血管病变。予以腹腔穿刺引出混合血性液体，考虑为腹腔隐匿性疾病，遂行剖腹探查术。术中诊断为腹内疝、小肠坏死和感染性休克， 行小肠部分切除术、吻合术、黏连松解术和腹腔冲洗引流术。术后患者恢复良好，于术后14 d康复出院。 结论 先天性腹内疝是一种非常少见的成年患者肠梗阻的原因，高度怀疑腹内疝是非典型急腹症的鉴别诊断之一，早期多学科干预可以挽救患者生命。

Abstract

Objective To discuss the clinical characteristics， diagnosis processes， and treatment methods of one patient with congenital intrabdominal hernia，and to summarize the potential misconceptions during the diagnostic and treatment processes， and to improve the clinicians’ awareness of this disease. Methods The clinical data and auxiliary examination results of one patient with congenital intrabdominal hernia were collected and analyzed， and the related literatures were reviewed. Results The patient， a 65-year-old male， sought care at the local hospital due to upper abdominal pain before 2 d；there were no significant abnormalities in the examination results at the cocal hospital；blood glucose>25 mmol·L^－1.After receiving hypoglycemic， rehydration， and blood purification treatment， the condition of the patient was worsened， presenting with confusion， hypotension， and respiratory distress；the patient admitted in our hospital for further diagnosis and treatment.After admission，the patient was given despite fluid resuscitation， mechanical ventilation， and supportive treatment， but there was no improvement in the symptoms；interventional radiology was performed angiography of the abdominal artery and right femoral vein， which showed no significant vascular abnormalities in the abdomen. An abdominal paracentesis yielded a mixed bloody fluid， suggesting the concealed intraperitoneal disease； exploratory laparotomy was performed. During operation， the intrabdominal hernia with small intestine necrosis and septic shock were diagnosed， and partial small intestine resection， anastomosis， adhesiolysis， and abdominal irrigation and drainage were carried out. The patient had a good recovery and was discharged on the 14th day after operation. Conclusion Congenital intrabdominal hernia is a very rare cause of intestinal obstruction in the adults，and high suspicion for intrabdominal hernia is one of the differential diagnosis for atypical acute abdomen；early multidisciplinary intervention can be lifesaving for the patients.

关键词

腹内疝 / 糖尿病高渗状态 / 乳酸酸中毒 / 脓毒症休克 / 不典型疼痛

Key words

Intrabdominal hernia / Diabetic hypertonic state / Lactic acidosis / Septic shock / Atypical pain

Author summay

杨 洋（1994－），女，黑龙江省佳木斯市人，医师，医学硕士，主要从事胃肠和结直肠疾病临床方面的研究。