陈旧性创伤性膈疝并绞窄性肠梗阻1例报告并文献复习

创伤性膈疝属胸科急症,但有部分病例起病隐匿,早期症状不多,一旦疝内容物发生绞窄性梗阻则发展迅速,甚至危及生命。现报告1例并结合文献对本病临床特点进行讨论。患者男性,26岁,因脐周疼痛伴左侧胸痛、呼吸困难8ｈ入院。8ｈ前无诱因于睡眠中突然脐周持续疼痛,进行性加重,伴左侧胸部及肩背部疼痛,呼吸困难,当地予以“杜冷丁、阿托品”治疗无效。既往于13岁时左侧背部刀刺伤,4年前出现“肠梗阻、肠套叠”,经导泻治疗好转。此后每年发作1～2次,均经导泻及解痉等治疗后好转。入院查体　体温368℃,脉搏:148次/ｍｉｎ,呼吸:40次/ｍｉｎ,血压:14/12…     

老年人结肠癌并肠梗阻86例临床分析

老年人结肠癌并肠梗阻临床表现多不典型，且常合并其他脏器的疾病，故临床诊断困难，而手术方式的选择及围手术期的处理与治疗效果密切相关。现对我院手术治疗老年人结肠癌并肠梗阻86例临床资料进行分析。     

老年系统性血管炎合并肠梗阻2例并文献复习

目的提高对老年系统性血管炎的认识。 方法回顾性分析2006年1月至2017年1月广州军区广州总医院收治的89例老年系统性血管炎患者的临床资料,重点分析其中合并肠梗阻的2例患者,分析其临床特点、诊疗过程以及预后。 结果老年系统性血管炎临床表现多样,发热为常见症状,常伴有乏力、咳嗽、头晕、胸痛、失眠等非特异性症状;全身各个脏器均可受累,以肾脏、肺脏受累最为常见;多数患者血沉、C反应蛋白可升高。合并肠梗阻的2例患者中,1例诊断为"过敏性血管炎",经激素联合吗替麦考酚酯治疗后病情好转;另1例因肠梗阻入院行手术治疗,误诊为"缺血性肠病",1年后患者出现进行性肾功能损害,血清胞浆型和核周型抗中性粒细胞胞浆抗体强阳性,修正诊断为"显微镜下血管炎"。因患者高龄未接受激素治疗,迅速出现急性肾功能衰竭,治疗无效死亡。 结论以肠梗阻为首发症状或并发症的老年患者需排除系统性血管炎,以免延误诊断治疗。     

老年人腹部手术后早期炎性肠梗阻35例

目的:对老年人腹部术后早期炎性肠梗阻的诊断、治疗和预防进探讨．方法:回顾分析35例腹部术后早期炎性肠梗阻的老年患者的临床资料．结果:老年人腹部术后早期炎性肠梗阻多发生在术后4-12 d,除表现为一般肠梗阻的症状体征外,还有其自身的特点,33例经非手术治疗痊愈,平均肠功能恢复时间为8±1d (4-28 d)．结论:老年人术后早期炎性肠梗阻采用保守治疗效果较满意,减少手术的创伤及抑制炎症反应对其发生有一定的预防作用．     

手术治疗老年人急性肠梗阻183例临床分析

目的 总结老年人急性肠梗阻的临床特点。方法 回顾性分析我院1992年10月至2001年10月经手术治疗183例老年急性肠梗阻患者的临床资料。结果 183例经手术治疗老年人急性肠梗阻中，嵌顿性疝占首位(43．2％)。本组同期收治老年人结肠癌中，40．6％(43／106)以急性肠梗阻为人院始发原因。本组19例左半结肠癌中，手术切除17例，其中12例行Ⅰ期吻合，2例并发吻合口瘘(16．7％)。围手术期病死率3．3％(6／183)，皆因手术过晚所致。结论 积极有效手术干预，可使大多数老年急性肠梗阻患者得到治愈或不同程度缓解。     

厚皮性骨膜病1例并文献复习

厚皮性骨膜病（pachydermoperiostosis,PDP）是一种罕见的良性疾病,病因未明。其临床特点为杵状指（趾）、骨膜新骨形成、皮肤增厚、回状头皮、皮肤溢脂、痤疮、关节肿胀疼痛及手足多汗等。现将我院最近诊断的1例PDP报告如下。 1临床资料 患者男,23岁,未婚。因肢端肥大10余年,双膝肿大伴四肢乏力7个月入院。患者诉10岁始无明显诱因出现四肢肢端无痛性进行性肥大。近一年来上症加重,肢端肥大明显。     

缩窄性心包炎1例并文献复习

1 病例资料 患者男,54岁,因"心慌、胸闷10余天,加重10 d"2018-02-09于济宁医学院附属医院心内科住院.既往有"脑梗死"、"尘肺"病史.自诉受凉后出现胸闷、憋喘、气短,伴咳嗽、咳痰,咳白色黏痰,不易咳出,步行不足50 m即可出现上述不适,休息数分钟后可缓解.入院查体:颈静脉充盈,未出现奇脉及Kussmu...     

回肠末端弥漫性大B细胞淋巴瘤并肠梗阻1例报道

原发性肠道淋巴瘤临床很少见,易误诊。     

Enteric neuropathology of congenital intestinal obstruction： A case report

Experimental evidence indicates that chronic mechanical sub-occlusion of the intestine may damage the enteric nervous system (ENS),although data in humans are lacking. We here describe the first case of enteric degenerative neuropathy related to a congenital obstruction of the gut. A 3-year and 9-mo old girl began to complain of vomiting, abdominal distension, constipation with air-fluid levels at plane abdominal radiology. Her subsequent medical history was characterized by 3 operations: the first showed dilated duodeno-jejunal loops in the absence of occlusive lesions; the second (2 years later) was performed to obtain full-thickness biopsies of the dilated intestinal loops and revealed hyperganglionosis at histopathology; the third (9 years after the hyperganglionosis was identified) disclosed a Ladd's band which was removed and the associated gut malrotation was corrected. Repeated intraoperative full-thickness biopsies showed enteric degenerative neuropathy along with reduced interstitial cells of Cajal network in dilated loops above the obstruction and a normal neuromuscular layer below the Ladd's band. One year after the latest surgery the patient tolerated oral feeding and did well, suggesting that congenital (partial) mechanical obstruction of the small bowel in humans can evoke progressive adaptive changes of the ENS which are similar to those found in animal models of intestinal mechanical occlusion. Such ENS changes mimic neuronal abnormalities observed in intestinal pseudoobstruction.     

以小肠穿孔为表现的嗜酸粒细胞性胃肠炎1例

嗜酸粒细胞性胃肠炎属于原发性嗜酸粒细胞性胃肠道疾病,是以胃肠道组织中嗜酸粒细胞异常浸润为主要病理组织特征,伴有外周血嗜酸粒细胞增多的少见胃肠道疾病[1].可累及整个消化道,好发于胃和小肠[2].该病因临床表现多样化,缺乏特异性,故误诊率较高.本研究收治1例嗜酸粒细胞性胃肠炎患者,以反复腹痛、小肠穿孔为主要症状就诊.现报...     

Primary intestinal lymphangiectasia in an adult patient: A case report and review of literature

BACKGROUNDPrimary intestinal lymphangiectasia (PIL), first described in 1961, is a rare disorder of unknown etiology resulting in protein-losing enteropathy. The disease is characterized by dilatation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia, and lymphopenia. Since the severity and location of lymph vessels being affected can vary considerably, the range of associated symptoms is wide from mild lower-limb edema to generalized edema, abdominal and/or pleural effusion, and recurrent diarrhea, among others. Although usually developing in early childhood, we present the case of a 34-year-old woman with PIL. Moreover, we performed a literature review systematically assessing clinical presentation, and provide a practical approach to facilitate diagnosis and therapy of PIL in adults.CASE SUMMARYOur patient presented with unspecific symptoms of abdominal discomfort, fatigue, nausea, and recurrent edema of the lower limbs. Interestingly, a striking collinearity of clinical symptoms with female hormone status was evident. Additionally, polyglobulia, hypoalbuminemia, hypogammaglobulinemia, and transient lymphocytopenia were evident. Due to suspicion of a bone marrow disease, an extensive diagnostic investigation was carried out excluding secondary causes of polyglobulinemia and hypoalbuminemia. The diagnosis of primary intestinal lymphangiectasia was established after 22 wk by histological analysis of biopsy samples obtained via enteroscopy. Consecutively, the patient was put on a high-protein and low-fat diet with medium-chain triglycerides supplementation leading to significant improvement of clinical symptoms until 2 years of follow-up.CONCLUSIONPIL can be the reason for cryptogenic hypoalbuminemia, hypogammaglobulinemia, and lymphopenia in adulthood. Due to difficulty in correct diagnosis, treatment initiation is often delayed despite being effective and well-tolerated. This leads to a significant disease burden in affected patients. PIL is increasingly been recognized in adults since the majority of case reports were published within the last 10 years, pointing towards an underestimation of the true prevalence. The association with female hormone status warrants further investigation.     

Stercoraceous perforation of the colon report of a case

Stercoraceous perforation of the colon is seen infrequently clinically, but the mortality of this entity remains high. Early diagnosis and treatment are essential if mortality is to be reduced. Emphasis is placed on the potential prevention of this entity. The case presented involves four confined stercoraceous perforations of the colon which were treated by resection and colostomy and from which the patient made a complete recovery.     

Diverticulosis of the jejunum with intestinal obstruction： A case report

A diagnosis of intestinal diverticulosis is difficult to make pre-operatively because the clinical symptoms are usually non-specific. We report the case of a 70-year-old man who had suffered from three episodes of intestinal obstruction in 1 year. He experienced dull pain and a sensation of fullness over the whole abdomen. The symptoms did not improve after conservative treatment. The presumptive diagnosis was intestinal obstruction, and an exploratory laparotomy found diverticulosis of the proximal jejunum, with an adhesion band formed from the base of one diverticulum. Strangulation of a segment of the jejunum resulted from the internal herniation caused by the band. The band was removed and the proximal jejunum segmentally resected. His postoperative course was uneventful.     

Multiple intestinal perforation in a patient with Wegener's granulomatosis: a case report and review of the literature

Wegener's granulomatosis is a necrotizing vasculitis of unknown etiology characterized mainly by inflammation of the small- and medium-sized arteries and veins that affect any viscera. It may rarely involve the gastrointestinal tract. Only a few cases of multiple focus ileal perforation due to ulcers associated with Wegener's granulomatosis have been reported. Herein we report a case of a 32-year-old man with extensive intestinal small bowel ischaemic perforation due to Wegener's granulomatosis.     

Idiopathic chronic ulcerative enteritis with perforation and recurrent bleeding: A case report

Idiopathic chronic ulcerative enteritis (ICUE) is a distinct entity without a defined etiology and is rarely seen in the clinic. Patients with ICUE mainly present with insidious abdominal symptoms such as chronic abdominal pain and intermittent gastrointestinal hemorrhage and symptoms of malnourishment in the early stages of the disease. ICUE is always difficult to diagnose. However, as the disease progresses, patients have a variety of acute abdominal complications such as hemorrhage, perforation, or ileus. Surgical intervention is always needed, and the condition can recur and require repeat laparotomy. When diffuse ulceration of the small bowel is present in the absence of recognizable causes, it is classified as nonspecific or idiopathic. The histological examination always demonstrates an acute, chronic inflammatory infiltration without giant cells, granulomas, or villous atrophy. The etiology of ICUE has not been identified, and its pathogenesis is poorly understood; therefore, radical surgical resection is considered the best available treatment. Here, we report a case of ICUE characterized by nonspecific, multiple, small intestinal ulcers resulting in perforation and recurrent bleeding. The differential diagnosis and the treatment are also discussed.     

Cervical cellulitis and mediastinitis following esophageal perforation：A case report

Chicken bone is one of the most frequent foreign bodies （FB） associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation. Cervical and mediastinal drainage were made immediately. Nasogastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Conclusion： Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.