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35002,女,11周岁。以“发作性腹痛3个月,加重12小时”入院,腹痛为左下腹,持续性,“刀割样”剧痛,难以忍受。查体:T35.8℃,P92次/分,R18次/分,BP11/9kpa,腹软,无包块,无压痛,左下腹轻反跳痛。血WBC6.4×10~9/L。诊断:肠痉挛,肠蛔虫症。经抗炎、解痉及止痛治疗,未缓解,入院第3天请外科会诊:诊断:肠系膜淋巴结炎,同意儿科治疗。入院第4天出现发热。体温37.9℃,腹痛为排尿、便时加重。便后稍缓解。腹部耻骨联合上1cm处触及近圆形包块,边缘模糊、柔软、变形、触痛明显。做B超检查:盆腔见约7.3×7.1cm实质不均匀肿物,见多个小腔区,形略不规则。请妇科会诊:月经未来潮。肛诊:后穹窿明显触痛,于宫颈右上方可及一直径约7cm大小似囊性包块,与子宫不能分开,左部附件未触及异常。有压痛,因患儿不合作,双合诊不甚满意。考虑卵
35002, female, 11 years old. With “onset of abdominal pain for 3 months, increased 12 hours” admitted, abdominal pain for the left lower quadrant, sustained, “knife-like” pain, unbearable. Physical examination: T35.8 ℃, P92 times / min, R18 beats / min, BP11 / 9kpa, abdominal soft, no mass, no tenderness, left lower abdomen reflex pain. Blood WBC 6.4 × 10 ~ 9 / L. Diagnosis: intestinal spasm, intestinal ascariasis. After anti-inflammatory, antispasmodic and analgesic treatment, did not ease, admission to the 3rd day, please surgical consultation: diagnosis: mesenteric lymphadenitis, agree pediatric treatment. On the 4th day of admission, fever occurred. Body temperature 37.9 ℃, abdominal pain is urination, then increased. After a little ease. The pubic symphysis on the abdomen touches nearly circular mass at 1cm, the edge is fuzzy, soft, deformity, tenderness is obvious. To do B-ultrasound: pelvic see about 7.3 × 7.1cm inhomogeneous mass, see a number of small cavity area, slightly irregular shape. Please gynecological consultation: menstrual future wave. Rectal examination: After a significant tenderness in the posterior fornix, at the top right of the cervix can be a diameter of about 7cm in size cystic mass, with the uterus can not be separated, the left attachment did not touch the exception. Have tenderness, because of children do not cooperate, not satisfied with the double joint clinic. Consider the egg