我院1990年以来收治破伤风患者24例,其中5例早期以急性腹痛为主要临床表现,误诊为急腹症,现报告如下。 临床资料 本组5例均为男性,年龄21～35岁,平均26岁。1例拇指甲沟炎;足及手指外伤4例。5例均以突然腹痛起病,表现全腹肌紧张、压痛及反跳痛,但无消化道症状,其中疑胃穿孔4例,坏死性胰腺炎1例。至入院后2～72h均出现典型破伤风症状而确诊。1例曾因此而行剖腹探查。确诊后予以破伤风治疗,痊愈出院。 典型病例 病人男,25岁。上腹剑突下疼痛7天人院。疼痛无明显规律,呃逆、恶心。查体:体温37℃,脉膊76次/分,呼吸19次/分,血压13/8kPa,神清,上腹剑突下肌紧张、压痛、反跳痛。住院后经治疗,腹痛范围扩展至全腹,呈板状腹。拟诊为消化性溃疡并穿孔。第3天出现四肢阵发性抽搐,下午胃镜检查时出现牙关紧闭,全身抽搐,角弓反张,颈项强直。再次追问 Twenty-four cases of tetanus patients since 1990 in our hospital, of which 5 cases of early acute abdominal pain as the main clinical manifestations, misdiagnosed as acute abdomen, are as follows. Clinical data The group of 5 patients were male, aged 21 to 35 years, mean 26 years. 1 case of thumb paronychia; foot and finger trauma in 4 cases. 5 cases were sudden onset of abdominal pain, the performance of total abdominal muscle tension, tenderness and rebound tenderness, but no gastrointestinal symptoms, of which 4 cases of gastric suspected perforation in 1 case of necrotizing pancreatitis. 2 to 72h after admission were typical symptoms of tetanus confirmed. One case had laparotomy for this reason. After the diagnosis of tetanus to be treated, discharged. Typical cases Patient Male, 25 years old. Upper abdominal xiphoid pain 7 days hospital. No obvious law of pain, hiccups, nausea. Physical examination: body temperature 37 ℃, pulse 76 beats / min, breathing 19 beats / min, blood pressure 13 / 8kPa, Shen Qing, upper abdominal xiphoid muscle tension, tenderness, rebound tenderness. After hospital treatment, abdominal pain range extended to full abdomen, was abdominal plate. To be diagnosed as peptic ulcer and perforation. On the third day, there were paroxysmal convulsions on the extremities. In the afternoon, gastroscopy was performed with trismus, generalized convulsions, angle arch reverse, and neck stiffness. Ask again