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患者杨树春,男,68岁,病案号48701。10年前在当地行阑尾切除,多次发作肠梗阻,均经治愈。入院前4d突然出现有中腹阵发绞痛,恶心伴吐胃肠内容物,排气排便停止。在当地医院保守治疗2d,症状未缓解来诊并收入院。 查体:体温36℃,脉率92次/min,血压14/12kPa,痛苦貌,腹部稍胀,右中下腹压痛,无肌紧张,叩诊腹为鼓音,可闻气过水声及高调肠鸣。X光透视:左上中腹区见多个阶梯液平。诊断为粘连性肠梗阻,置胃管,灌肠、补液,抗感染观察治疗。第3天腹痛加剧,腹胀明显,查左中腹不对称肠型,考虑闭袢性肠梗阻,分析有索状粘连或内疝可能,遂急诊全麻下经腹腔镜检查。
Patients Yang Shuchun, male, 68 years old, medical record number 48701. 10 years ago in the local appendectomy, multiple episodes of intestinal obstruction, were cured. 4d before admission, abrupt onset of abdominal colic nausea, nausea and vomiting gastrointestinal contents, exhaust defecation stopped. Conservative treatment in the local hospital 2d, the symptoms did not ease to the clinic and income homes. Physical examination: body temperature 36 ℃, pulse rate 92 beats / min, blood pressure 14 / 12kPa, painful appearance, abdominal swollen, right lower abdomen tenderness, no muscular tension, percussion belly drum sound, Ming X-ray: upper left middle abdomen to see more than one ladder level. Diagnosis of adhesive intestinal obstruction, stomach, enema, rehydration, anti-infection observation and treatment. Day 3 increased abdominal pain, abdominal distension significantly, check the left abdominal asymmetric intestinal type, consider closed intestinal obstruction, analysis of cord-like adhesions or internal hernia may, then emergency under general anesthesia by laparoscopy.