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病例介绍患者,女25岁。因停经6~+月腹痛呕吐4h就诊。腹痛呈持续性,以上腹部为重,呕吐物开始为胃内容物,以后呈血性。发病当日大便一次。40d前因肠梗阻行手术治疗。查体:T35.4℃,面色苍白,脉搏扪不清,Bp7,3/5.3kPa.腹膨隆,宫底脐上3cm,上腹有压痛,无反跳痛。查血常规Hb 12g/L,RBC 4.2×10~(12)/L,WBC 16×10~9/L,N87％.尿(一)。B超诊断肝硬化腹水;双胎头,无胎心搏动。腹透:无肠胀气。内、外、妇科会诊意见:中期妊娠、双胎、死胎、上消化道出血。经补液血压升至13.3/10.7kPa。入院后9h腹胀加重,左腹部出现反跳痛,腹透有肠胀气。腹穿抽出暗红色液
Case description Patient, female 25 years old. Due to menopause 6 ~ + abdominal pain vomiting 4h treatment. Abdominal pain was persistent, above the abdomen as heavy, vomit began to stomach content, after bloody. The stool on the day of onset. 40d ago due to surgical treatment of intestinal obstruction. Physical examination: T35.4 ℃, pale, pulse palpable, Bp7,3 / 5.3kPa. Abdominal distension, uterus 3cm on the uterus, upper abdominal tenderness, no rebound tenderness. Blood routine Hb 12g / L, RBC 4.2 × 10-12 / L, WBC 16 × 10 ~ 9 / L, N87% urine (a). B-diagnosis of cirrhosis and ascites; twin fetal head, no fetal heartbeat. Abdominal penetration: no flatulence. Internal and external, gynecological consultation See: mid-term pregnancy, twins, stillbirth, upper gastrointestinal bleeding. The fluid pressure rose to 13.3 / 10.7kPa. 9h after admission increased abdominal distension, left abdomen reflex pain, abdominal flatulence flatulence. Abdominal wear out dark red liquid