阿米巴肝脓肿的治疗

阿米巴肝脓肿的治疗多主张以内科治疗为主。如病情不严重,脓肿较小,则单纯以药物治疗即可。如病情严重,脓肿较大,则以药物治疗的同时,配合肝穿刺抽脓。湖北省分析1078例的有效率达95.4％,病死率为3.9％。一般认为疗效与下列因素有关;①阿米巴毒力和患者的抵抗力;②感染的阶段;③脓肿的大小和数目;④有无继发性细菌感染;⑤脓肿有无穿破;⑥治疗方法是否恰当等。Bakey氏等统计单纯性阿米巴脓肿的死亡率为5％,而有继发感染者高达40％。如已出现脓肿自发性穿破,病死率将达75～100％。因此,本病应强调早期诊断,及早合理治疗。一、抗阿米巴药物有2类:①对肠外阿米巴感染有效的药物,如灭滴灵、氯喹、吐根素、去氢吐根素等,其中灭滴灵还兼有     

盆腔脓肿12例分析

目的 探讨减少盆腔脓肿(PA)的误诊及治疗方法.方法 对12例PA患者病史、诊治经过及转归进行回顾性分析.结果 本组误诊率为41.7%.11例住院手术治疗,10例随访1年无下腹痛及盆腔包块现象.结论 详细的病史采集(尤其是月经史,既往史)及严格的体格检查可以减少误诊.手术治疗PA具有治疗及时、疗效好、恢复快等优点.     

内镜超声引导下对胰腺脓肿、肝脓肿的介入治疗

胰腺脓肿系指腹腔内邻近胰腺部位的脓液积聚,可以来源于胰腺的局限性坏死液化感染,也可来自胰腺假性囊肿的继发感染.肝脓肿为消化系统的常见病,是肝脏继发感染性疾病,多由于细菌或阿米巴原虫感染所致,形成多发性小脓肿,进而融合成较大脓肿.传统治疗方法有外科手术和经皮穿刺引流辅以抗生素治疗.     

阿米巴肝脓肿30例临床分析

阿米巴肝脓肿是临床常见病.我院自1997年1月～1998年5月共收治30例,现报道如下.     

克隆病致脾脓肿1例

病例报告男，５５岁．间歇腹泻、发热、贫血、消瘦、乏力１０ａ．曾因混合痔感染发热，贫血原因待查住院四次．本次发热Ｔ３９９℃，寒颤．白细胞３２×１０９／Ｌ，中性０８４，红细胞２２０×１０１２／Ｌ，血沉７０ｍｍ／ｈ，体重４８ｋｇ．Ｂ超：脾脓肿．入院...     

细菌性肝脓肿的诊治

细菌性肝脓肿是发生干肝脏的一种继发性感染,在临床上并不少见,有时还是致命的。近一个世纪以来,由于原发疾病的有效控制,抗生素的应用,影象检查的发展以及治疗方法上的进步,肝脓肿无论是在病因、病程及预后上都有了很大的变化,在20世纪最初的30年间,发生肝脓肿的常见原因是急性阑尾炎,总体死亡率达75％～80％;到20世纪50～70年代,引发肝脓肿的主要原因已转为良、恶性胆道梗阻,所发生的脓肿类型多数是多发性脓肿,总体死亡率高达45％～50％。在最近的20年中,由于B超和CT影象技术的发展,在影象引导下作脓肿穿刺或经皮引流术,使得肝脓肿的诊断和治疗有了极大的进步,目前肝脓肿的总体死亡率约在6％～25％之间。     

Meckel's diverticulum manifested by a subcutaneous abscess

This case report describes an extremely rare complication of a Meckel's diverticulum: enterocutaneous fistula of the diverticulum. The presence of Meckel's diverticulum is a well known entity, but subcutaneous perforation of the diverticulum is very rare. Here we report the case of a patient with the complaint of a right lower quadrant abscess, preoperatively diagnosed as enterocutaneous fistula, which was determined intraoperatively to be a fistula resulting from Meckel's diverticulum.     

Intususcepción ileocólica en un adulto causado por divertículo de Meckel invertido

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is found in 2.00% of the population and is more frequent in children. Invagination is an unusual complication that can cause secondary intestinal intussusception. This event is extremely rare and only a few cases have been reported. We present the case of a 19-year-old male who presented with chronic abdominal pain and weight loss of 23 Kg 6 months prior to hospital admittance. The last episode manifested as intense abdominal pain, nausea, vomiting, and diarrhea with a 6-hour progression. Imaging studies established the diagnosis of bowel obstruction and ileocolic intussusception. Laparotomy with ileocolic resection was performed without reducing the intussusception. The histopathologic study reported inverted Meckel's diverticulum at the base of the ileocolic intussusception. Intestinal intussusception in adults, secondary to inverted Meckel's diverticulum is rare and should be considered in the differential diagnosis of patients presenting with abdominal pain and bowel obstruction.     

Divertículo de Meckel y enterolitos como complicación de la enfermedad de Crohn

We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohńs disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease.     

Digestive complications of gallstones lost during laparoscopic cholecystectomy

IntroductionSerious complications can ensue if a gallstone is dropped into the peritoneal cavity during laparoscopic cholecystectomy and not retrieved.Case outlineA 75-year-old-man was admitted with intestinal obstruction 8 years after laparoscopic cholecystectomy. Ultrasound scan and a contrast x-ray of the small bowel showed a gallstone within the small bowel lumen that CT scan had failed to identify. Laparotomy showed a Meckel''s diverticulum plus a 4×6-cm gallstone in the terminal ileum. The gallstone had penetrated into the Meckel''s diverticulum before migrating into the ileum and obstructing it.DiscussionGallstones lost during laparoscopic cholecystectomy can cause an intraperitoneal abscess. In addition, they can migrate through the anterior or posterior abdominal wall or the diaphragm and into the urinary tract or bronchus. The resulting abscess can obstruct the digestive tract or drain into the digestive tract to cause a communicating abscess. It can also drain through the abdominal wall and the digestive tract to cause an enterocutaneous fistula. Lastly, the stone can migrate into the intestine and cause gallstone ileus. Following laparoscopic cholecystectomy, patients with a lost gallstone may suffer from abdominal pain and fever within days or months. Thus, all dropped gallstones should be removed during laparoscopy.     

Meckel's Diverticulum��Revisited

Meckel''s diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. In about 50% cases, it contains ectopic or heterotopic tissue which can be the cause of complications. A systematic review of literature was undertaken to study the history, incidence, embryoanatomy, clinical presentation, complication and management of Meckel''s diverticulum. Although Meckel''s diverticulum is the most common congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain asymptomatic or it may mimic disorders such as Crohn''s disease, appendicitis and peptic ulcer disease.     

Perforation of Meckel’s diverticulum with enteroliths

Perforation of Meckel??s diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel??s diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel??s diverticulum was identified approximately 90?cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient??s postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel??s diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.     

Meckel's diverticulum masked by a long period of intermittent recurrent subocclusive episodes

Meckel＇s diverticulum （MD） is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting, symptoms erroneously related to a cyclic vomiting syndrome but not to MD. The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.     

HETEROTOPIC GASTRIC MUCOSA IN MECKEL'S DIVERTICULUM INCIDENTALLY FOUND BY DOUBLE BALLOON ENTEROSCOPY

A 45‐year‐old Japanese man who had been suffering from intestinal‐type Behcet's disease was referred to Yamagata University Hospital for enteroscopic examination. Double balloon enteroscopy was performed via the anal route. We identified ulceration of the terminal ileum that was detected previously. In addition, we incidentally recognized a Meckel's diverticulum coexisting with a heterotopic mucosal island nearly 100 cm on the oral side from the ileocecal valve. Meckel's diverticulum did not accompany ulcers and there was no history of bleeding. The heterotopic mucosal island was confirmed as gastric mucosa from biopsy specimens. High‐resolution endoscopic features of heterotopic gastric mucosa in Meckel's diverticulum using a double balloon enteroscopy are considered informative images.     

Enterocolic fistula: A rare presentation of cytomegalovirus infection

In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.     

A case of duodenal diverticulum accompanied with choledochoduodenal and pancreaticoduodenal fistulas]

Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.