小肠憩室引起小肠梗阻

患者男,29岁,因间断腹痛1个月余入院.患者于1个月前无明显诱因出现腹痛,呈剧烈绞痛,脐上明显,严重时向背部放射,持续30 min～2 h不等,深压可缓解,进食后加重,无明显腹胀,曾于当地医院治疗(具体不详),效果不明显,症状反复.     

小肠憩室4例误诊分析

我院于1989年10月至1992年4月收治4例有并发症的小肠憩室病人,开始均误诊。为提高对本病及其并发症的认识,结合此4例讨论其误诊原因。     

小肠憩室152例临床分析

小肠憩室是一种常见的消化道疾病，资料统计发病率约为5％～25％，在消化道憩室中居首位。本文分析了152例小肠憩室的临床与病理资料，旨在提高对小肠憩室病的认识。     

小肠憩室并发肠梗阻的诊治体会

目的总结成人小肠憩室合并肠梗阻的诊断及治疗方法。方法回顾性分析我院2012年1月至2014年12月收治的12例以并发肠梗阻为主要表现的小肠憩室患者临床资料,总结有效的诊断和治疗方法。结果 12例患者的肠梗阻均由小肠憩室引起,其中术中诊断8例,术前CT及消化道碘水造影诊断4例。所有患者均手术治疗,1例患者死亡,共有3人出现腹腔感染、切口感染等并发症,余均康复出院。结论对于以肠梗阻为主要表现的小肠憩室,术前诊断非常困难,肠梗阻患者均应排除小肠憩室的可能性,尤其是存在腹膜炎体征或不明原因的肠梗阻,且经长时间的保守治疗不能缓解或缓解不明显者,此时应积极手术探查,了解具体原因,以免延误诊断,造成不可挽回的后果。CT检查对于不明原因的肠梗阻术前诊断、明确病因、制定治疗方式有一定帮助,消化道碘水造影对于不全性肠梗阻的患者不仅可以起到诊断作用,还有治疗效果。由于腹腔镜的微创性,不仅作为治疗手段还可作为检查方式,对小肠憩室的诊断也有非常重要的意义。     

双气囊内镜诊断小肠憩室穿孔一例

患者女,61岁,因阴道有粪水流出1个月余入院。患者入院前半年出现中下腹间歇性隐痛,伴低热,体温最高37．8℃,伴夜间盗汗、消瘦,无腹泻、便秘。当地医院下腹部CT检查示盆腔包块,于抗炎补液治疗后好转。1个月前无明显诱因下出现阴道有黄色粪水溢出,伴下腹间歇性疼痛,有呕吐,呕吐物为胃内容物,含有胆汁,伴腹胀、腹泻。     

小肠憩室致下消化道大出血1例

患者男性 ,6 6岁 ,突然上腹痛 ,便血、晕厥 1次 ,于 2 0 0 0 - 0 3 - 18入院。1ｈ前患者无明显诱因出现上腹持续性隐痛 ,便血约 80 0 ｇ ,并感头晕、心慌、全身乏力、畏寒 ,晕厥 1次约 10ｍｉｎ ,不伴呕吐咖啡色样液体或呕血。急送我院于门诊经扩容、止血治疗后好转收入我科。患者既往无类似发作史 ,否认慢性肝炎和血吸虫病史。查体 :体温36 2℃ ,脉搏 10 0 /ｍｉｎ ,呼吸 2 3/ｍｉｎ ,血压 14/10ｋＰａ ,发育正常 ,营养中等 ,贫血貌 ,神志清楚。皮肤粘膜无黄染 ,无肝掌和蜘蛛痣。心肺无异常。腹部平坦 ,质软 ,中上腹轻压痛 ,无肌紧张 ,无…     

胶囊内镜对小肠憩室的诊断价值

背景:小肠憩室是常见的消化道畸形,术前诊断困难。目前关于胶囊内镜对小肠憩室的诊断敏感性尚存在争议。目的:分析小肠憩室的临床特点,评价胶囊内镜对小肠憩室的诊断价值。方法:纳入2002年5月-2013年8月于上海交通大学医学院附属仁济医院行胶囊内镜检查并经手术或双气囊小肠镜确诊的小肠憩室患者,对患者一般情况、病变部位、临床表现、诊断情况、治疗方法和预后进行回顾性分析。结果:共33例患者纳入研究,其中男23例,女10例,平均年龄(41.4±21.9)岁,平均病程(41.4±39.3)个月。小肠憩室位于十二指肠3例,空肠6例,回肠24例。临床表现中消化道出血发生率为87.9%(29/33),腹痛、腹泻发生率为12.1%(4/33),贫血发生率为97.0%(32/33)。胶囊内镜对小肠憩室的诊断率为15.2%(5/33)。11例患者行手术治疗,22例患者接受对症处理。结论:胶囊内镜诊断小肠憩室不敏感,对于高度怀疑小肠憩室的患者,不应作为首选检查手段。     

小肠多发憩室并肠系膜扭转1例报告

患者,女,63岁,因反复上腹痛2年,加重1个月于2007年1月16日入院。患者2年前无明显诱因反复出现上腹痛,多为胀痛,进食后明显,偶有阵发性绞痛,伴反酸、嗳气,无恶心、呕吐,无腹泻。曾在外院行腹部超声、胃镜、结肠镜等检查未见异常,按"慢性胃炎"治疗无好转,症状时轻时重。每月均     

双气囊小肠镜在青少年小肠憩室出血中的诊断价值

目的探讨双气囊小肠镜(double-balloon enteroscopy,DBE)在青少年小肠憩室出血中的诊断价值。方法回顾性分析2007年7月-2015年9月武汉大学人民医院消化内镜中心行DBE检查并诊断为小肠憩室出血的37例青少年患者病历资料。结果DBE检出37例小肠憩室出血患者,其中少年组7例(男4例,女3例),青年组30例(男28例,女2例),组间性别构成比差异有统计学意义(P0.05);患者主要首发症状表现为便血、黑便,其中便血13例(35.14%)、黑便24例(64.86%),差异有统计学意义(P0.01);憩室部位主要包括十二指肠憩室1例(2.70%)、空回肠憩室34例(91.89%)、Meckel憩室2例(5.41%),患者小肠憩室部位分布差异有显著统计学意义(P0.01);有7例小肠憩室出血患者行切除手术治愈,术中憩室位置与DBE确定位置一致,随访无复发;所有患者行DBE检查均未出现明显不良反应和严重并发症。结论 DBE不仅能有效诊断青少年小肠憩室出血,还能为外科手术提供可靠依据,且安全性较高。     

Diverticulosis of the small intestine

Seven patients with small-intestinal diverticulosis were studied by means of intestinal absorptive tests, biopsies, and bacterial cultures of small-intestinal aspirates. Aerobic bacterial cultures were obtained in all patients, while anaerobic cultures with a modified Hungate roll-tube technic were performed in 3. Three of the patients manifested steatorrhea and were studied over prolonged periods of time. The bacterial flora varied over a wide quantitative range, with highest total counts in excess of 10⁹ colony-forming units per milliliter found in the 2 patients with the most severe malabsorption. Despite multiple diverticulosis, 1 patient without steatorrhea had no recoverable aerobic or anaerobic bacterial flora. E. coli predominated among the recovered aerobic organisms in this series, but A. aerogenes and various streptococci also were encountered repeatedly. Patients treated with antibiotics directed at the aerobic flora showed prompt improvement in absorption, and reduction in bacterial counts. Repeated short courses of antibiotics were needed to treat early bacteriologic and clinical relapses. After several such courses, all 3 patients treated maintained their clinical and metabolic improvement for periods of close observation ranging from 2 to 15 months without additional antibiotic treatment, and the clinical remissions were accompanied by gradual reductions in total bacterial counts to “borderline normal” limits. Of the 3 patients, 1 has now been followed for 5 years without relapse. It is apparent that the mere presence of diverticulosis does not lead necessarily to malabsorption. Malabsorption of fat, Vitamin B₁₂, and other nutrients was found only in patients with excessive bacterial flora, emphasizing the crucial role bacteria play in the pathogenesis of malabsorption in diverticulosis of the small intestine.     

Parasites of the small intestine

This paper discusses the most important parasites that inhabit the human small intestine. Beginning with the protozoa and proceeding through the various species of cestodes, nematodes, and trematodes that inhabit the human small bowel, the most important organisms are presented. Possible future developments are discussed along with pathophysiology and treatment in this phylogenic approach. Zoonotic illnesses, those diseases that by their rarity are of little import, and diseases without significant clinical or social implications are beyond the scope of this article and are not discussed.     

Adenomyoma of the small intestine

Adenomyoma of the gastrointestinal tract is a rare benign tumor-like lesion.The small intestine is the second most frequent location,usually in the periampullary area,but the lesion also occurs in the jejunum and ileum.While adenomyoma of the Vaterian system is primarily diagnosed in adults,more than half of reported cases of jejunal and ileal adenomyoma have been diagnosed in pediatric patients.Adenomyoma of the periampullary area usually presents with biliary obstruction or abdominal pain,whereas jejunal and ileal adenomyoma usually presents with intussusception or is incidentally discovered during surgery or autopsy.Since endoscopic and radiological examination yields uncharacteristic findings,histopathological evaluation is important in adenomyoma diagnosis.Pathologically,adenomyoma consists of glandular structures of various sizes and interlacing smooth muscle bundles that surround the glandular elements.The pathogenesis of adenomyoma is generally considered to be either a form of hamartoma or a pancreatic heterotopia.Although limited resection is considered the most effective treatment,pancreaticoduodenectomy is often performed when the lesion occurs in the periampullary area due to preoperative misdiagnosis as a carcinoma.It is,therefore,important that clinicians and pathologists maintain current knowledge of the disease to avoid inaccurate diagnosis,which could lead to unnecessary surgery.