Acute Surgical Abdomen Due to Phytobezoar-induced Ileal Obstruction

Background

Phytobezoar-induced small bowel obstruction is an uncommon clinical entity accounting for 2–4.8% of all mechanical intestinal obstructions. In addition, presentation with features of acute surgical abdomen is extremely rare, accounting for only 1% of the patients.

Objectives

The aim of this report is to present a very rare case of a phytobezoar-induced small bowel obstruction in a male patient who presented with acute surgical abdomen. A correct preoperative diagnosis was made based on the patient’s history and characteristic imaging features on the emergency computed tomography (CT) scan.

Case Report

A 55-year-old man with previous gastrectomy presented with typical manifestations of acute abdomen. CT scan demonstrated dilatated small bowel loops and an intraluminal ileal mass with a mottled appearance. At exploratory laparotomy, a phytobezoar was found impacted in the terminal ileum and was removed through an enterotomy.

Conclusions

Phytobezoar should be considered in patients with previous gastric outlet surgery who present with bowel obstruction and features of acute surgical abdomen. The presence of a well-defined intraluminal mass with a mottled gas pattern on emergency CT scan is suggestive of an intestinal phytobezoar.     

Esophageal Obstruction and Death in a Nonverbal Patient

BackgroundThere are more than 100,000 cases of esophageal foreign body in the United States each year. Most cases resolve spontaneously; however, complete esophageal obstruction is a medical emergency. Patients with developmental disabilities are at high risk, because a large percentage of this population is effected by dysphagia, pica, tooth loss, or impulsive swallowing. In some cases, the diagnosis of esophageal foreign body can be made clinically, with the typical presentation including coughing, inability to tolerate secretions, drooling, vomiting, and dysphagia. In other instances, imaging is needed to confirm the diagnosis.Case ReportA nonverbal adult patient with history of mental retardation and dysphagia presented to the emergency department (ED) after a choking episode with persistent coughing. An x-ray study of the chest showed mild opacity at the left lung base and she was discharged with antibiotics. She returned to the ED that day with worsening symptoms suggestive of aspiration pneumonia. A computed tomography scan of the chest revealed numerous cylindrical objects in the esophagus, later identified as crayons. At least 28 crayons were removed via 3 endoscopies. During this time, the patient developed aspiration pneumonia, respiratory distress, and septic shock.Why Should an Emergency Physician Be Aware of This?Delayed recognition of foreign body puts patients at risk for esophageal perforation, aspiration, airway compromise, infection, sepsis, and death. In nonverbal patients presenting with upper respiratory symptoms, it is especially important to consider esophageal foreign body in the differential diagnosis, because this group is high risk for missed diagnosis and complications secondary to the foreign body.     

急性梗阻性尿路结石的腔内镜治疗

目的：探讨腔内镜治疗急性梗阻性尿路结石的可行性和效果。18例急性尿路梗阻病人,其中孤立肾单侧输尿管结石12例,双侧输尿管结石6例。所有病人血肌酐升高,其中4例血肌酐＞1000mmol/L。所有病人均急诊行输尿管镜下弹道碎石、取石、置管术。结果：5例病人结石取净,12例结石击碎,1例结石滑入肾盂,同时置放双“J”管或输尿管导管,尿路梗阻均得以解除。结论：输尿管镜术治疗急性梗阻性尿路结石效果好,值得临床推广。     

Children''s Response to Acute Pain: A Developmental Approach

Pain in children is a major concern of health care providers. To adequately relieve children's pain, nurses and other health care providers must be able to determine when children of all developmental stages are experiencing pain. The purpose of this article is to review what is known about children's response to acute pain.     

急性阑尾炎致肠梗阻漏诊原因分析

急性阑尾炎与肠梗阻同为外科常见急腹症,许多经典专著中没有提到急性阑尾炎的并发症有肠梗阻,文献亦很少报道。因此当急性阑尾炎合并有肠梗阻时极易漏诊原发病急性阑尾炎,仅按肠梗阻处理,当治疗效果不好或出现阑尾穿孔形成继发性腹膜炎时,才考虑手术。我院1998年1月~2005年1月共收治急性阑尾炎850例,其中35例并发急性肠梗阻,占4·12%。35例入院均诊断为肠梗阻而漏诊阑尾炎,现分析漏诊原因如下。1临床资料1·1一般资料本组35例,男21例,女14例;年龄8~75岁,平均年龄39·5岁。病程12小时~5天。1·2临床表现35例均有腹痛、腹胀、呕吐、肛门停止排…     

Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review

Background

Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine–focused literature concerning these conditions.

急性绞窄性肠梗阻10例误诊分析

1998年1月-2004年9月我院接诊急性绞窄性肠梗阻28例,其中误诊10例,误诊率35．7％。现将误诊原因分析如下。     

Sudden-onset Severe Acute Asthma: Clinical Features and Response to Therapy

Abstract. Objectives : To characterize patients with sudden onset of severe acute asthma (SAA) and to examine whether this presentation is associated with rapid recovery. Methods : Retrospective cohort study of ED visits to a teaching hospital. Subjects were aged 18–64 years, with SAA ( n = 225), denned as initial peak expiratory flow rate (PEFR) ≤40% of predicted. Visits for sudden-onset SAA (≤3 hours of symptoms) were characterized and multivariate logistic regression was used to examine the association between sudden onset and rapid recovery. Results : Patient visits for sudden-onset SAA had different triggers as compared with those for the slower-onset group (p = 0.006). The sudden-onset patients were less likely to report an upper-respiratory-tract infection (17% vs 40%) and more likely to have an unidentifiable trigger (40% vs 19%). In the multivariate logistic regression model, sudden onset was a strong independent predictor of rapid response [odds ratio (OR) 4.3, 95% confidence interval (CI) 1.6–11.6]. Sudden-onset visits were less likely to lead to admission (23% vs 43%, p = 0.03). Conclusions : These data suggest that different triggers may be involved in sudden-onset SAA and that sudden onset of symptoms is independently associated with rapid recovery. In their rapid deterioration and rapid response, these subjects share certain characteristics with "sudden asphyxic asthmatics" and may constitute a population suitable for further study of factors contributing to that condition. While these visits led to admission less frequently, prospective studies are necessary to provide information on duration of response and risk for relapse.     

双侧输尿管结石致急性肾功能衰竭的腔内处理

目的：探讨双例输尿管结石梗阻致急性肾功能衰竭的治疗方法。方法：应用输尿管镜直视下气压弹道碎石治疗输尿管结石梗阻并急性肾功能衰竭20例。结果：术后全部患者尿毒症症状减轻或消失，血Bun，Cr均不同程度降低或恢复正常。结论：输尿管镜直视下气压弹道碎石治疗输尿管结石梗阻并发急性肾功能衰竭具有安全、疗效可靠、损伤小的优点，能同时处理双侧输尿管病变。     

吸入有毒烟雾致急性喉梗阻急诊治疗

目的：探讨吸入有毒烟雾致急性喉梗阻的急诊保守治疗的有效措施。方法：对13例患者采取全身综合抗过敏及持续药物雾化吸入治疗。结果：除1例因疗效不佳行气管切开术外，余下12例均于40～90min左右症状缓解。结论：吸入有毒烟雾致急性喉梗阻者若及时给予综合性抗过敏及雾化吸入治疗，绝大多数可以避免气管切开。     

急性食管粘膜损伤内镜诊断价值与临床意义分析

该文分析了４７２９２例患者在上消化道内镜检查中,发现急性食管粘膜损伤１２６例,占同期内镜检查的０．２３％。发病发年龄以中、青年多发为７６．２％（９６／１２６）,损伤部位多发生于食管中上段,占９０．５％（１１４／１２６）。与食管钡餐检查进行比较,内镜确诊率和食管钡检率分别为１００％（１２６／１２６）,３４．９％（１５／４３）,两者之间有显著性差异（Ｐ〈０．０１）。提示急性分管粘膜损伤内镜检查较食管钡     

64排螺旋CT诊断急性肠梗阻

2009年11月～2011年2月我院收治并确诊的急性肠梗阻患者28例行64排螺旋CT检查,结果诊断结果1的肠梗阻病因诊断准确度为89.29%(25/28),诊断结果3为85.71%(24/28),诊断结果2为96.43%(27/28),诊断结果4为92.86%(26/28)。64排螺旋CT诊断急性肠梗阻具有很高的临床价值,能够有效提高肠梗阻诊断的准确率,是急性肠梗阻诊断的重要手段。     

食管肉骨填塞急诊内镜治疗35例体会

自 1 992年以来我们诊治各种食管损伤 ,异物1 2 4例 ,其中较严重的食管填塞 3 5例内镜下手术成功 ,报告如下 :1　资料与方法1 .1　般资料共 3 5例。男 2 1例 ,女 1 4例。年龄 1 0～ 78岁 ,平均 5 7岁。其中 40岁以下 1 7例 ,40～ 60岁 1 1例 ,60岁以上 7例。食管填塞主要原因系进食不慎 ,误吞及咀嚼不当等 ,其中吞入猪排肉骨 9例 ,鸡鸭肉骨 1 3例 ,牛肉筋块 5例 ,鱼肉骨 8例。填塞情况 :由一次吞噎造成阻塞 2 2例 ,疑肉骨、刺食管嵌塞用吞噎饭团、韭菜等造成填塞 7例 ,因Ｘ线检查吞入钡絮填塞 6例。1 .2　临床表现起病至诊治时间为 3 0～ 72…