术前诊断文氏孔疝一例
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)(2010)
Abstract
患者男性,59岁.晚饭后4 h,睡眠中突然剧烈腹痛,伴腹胀、恶心、呕吐,排软便4次,2 h后于肠道科就诊.急查血常规:WBC 10.6×109/L,N 0.75,Hb 12.6 g/L,PLT12.6×1010/L;便常规(-),便OB(-);T37.1℃,P 90次/min,R 23次/min,BP 136/82 mm Hg.按急性胃肠炎对症治疗,共治疗48 h无效并加重,同时伴有停止排便、排气.于消化科就诊,急查立位腹平片,提示急性肠梗阻收入我院外科.既往体健,无外伤及手术史.查体:T37.5℃,P 130次/min,R 30次/min,BP 70/50 mm Hg;神志恍惚、急性痛苦病容、面色稍苍白,胸膝卧位,呻吟、辗转;心率快、律齐,双肺呼吸音清;上腹部膨隆,未见腹壁静脉曲张,可见胃型,未见蠕动波,上腹压痛、反跳痛明显,腹肌紧张,未扪及明显腹部包块,肝脾未触及,叩呈鼓音,移动性浊音(±),肠鸣音听诊消失.
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