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患者女性,15岁。腹痛、便血1天。4个月来感有脐周隐痛,呈阵发性加剧,伴右下腹有块物隆起,时有腹泻,便血及高热,经对症处理可缓解。本次又便血不止,伴头晕眼花等休克入院。检查:慢性病容、消瘦、营养极差、重度贫血。体温38℃,脉搏126次/分,全身浅表淋巴结无增大,心肺正常。腹部轻度胀气,肝剑突下3cm,脾肋下触及,右下腹较饱满,可扪及6×4cm条状肿块。拟诊:下消化道出血待查。经过保守治疗,血止、热退、病情趋向稳定。钡灌检查,显示回盲部肠壁增厚,缩短变形伴息肉样充盈缺损,粘膜破坏。意见:增殖性结核可能。逐试行抗痨治疗,疗程中第16天突发脐周绞痛和大量多次鲜红血便,腹肌紧张、血压下降、决定急
Female patient, 15 years old. Abdominal pain, blood in the stool for 1 day. In the past 4 months, pain in the peri-umbilical cord was felt, and paroxysmal intensification was observed. There were swellings in the right lower abdomen with diarrhea, blood in the stool, and high fever. Symptomatic treatment relieved the symptoms. This time there was more than blood, with dizziness and other shock admission. Check: chronic disease, weight loss, poor nutrition, severe anemia. Body temperature 38 °C, pulse 126 beats / min, no increase in superficial lymph nodes, normal heart and lung. Mild flatulence in the abdomen, 3 cm below the xiphoid liver, subpleural and subpleural access, and fullness in the right lower abdomen, can be seen in 6×4 cm strips. To be diagnosed: Lower gastrointestinal bleeding is pending. After conservative treatment, the blood stopped, the heat retreated, and the condition tended to be stable. Bacterial irrigation examination showed thickening of the intestinal wall of the ileocecal region, shortening of the deformed polypoid filling defects, and destruction of the mucosa. Comment: Proliferative tuberculosis may. Trial-based anti-tuberculosis therapy was performed. On the 16th day of treatment, sudden cramps in the umbilical cord and a large number of bright red bloody stools occurred. Abdominal muscle tension, blood pressure decreased, and anxiety was determined.