患者,男,36岁。因反复左上腹痛1年余,加重3d,拟“腹痛待查”收入我院。既往有左上腹隐痛史。神志清,消瘦,腹胀,腹肌紧张,全腹压痛(+),以左上腹为甚,移动性浊音(++),肠鸣音亢进,有气过水音。胸片未见异常;腹部平片见多个阶梯样液平。诊断:结核性腹膜炎、肠梗阻。经内科治疗10d,未见好转。腹痛、腹胀、呕吐明显。拟“肠梗阻”转入外二科,在硬膜外麻醉下行剖腹探查术,术中见小肠、横结肠、升结肠高度扩张,降结肠及乙状结肠空虚,结肠脾曲处有一肿块,与胰腺尾部、脾脏、胃及左侧膈肌紧密粘连,形成大肿块,肿块与胃大弯侧及后壁粘连并相通胃腔(肿瘤切除后解剖所见),左脶面呈颗粒样改变,肝、胆未见异常。行左侧膈肌部分切除、胃空肠吻合、结肠端端吻合术(左胸腔置管闭式引流及上腹部置管引流)。术中切除肿瘤后结肠近端减压并插入尿管用大量生理盐水及0.7%灭滴灵液反复冲洗,术中输血1820ml,输液600ml。术后第7天胸片示:左胸腔少量积液,左肺受压2/3,给予胸腔抽气抽出约750ml,胸腔每㈠引出约100ml淡黄色液体,腹腔每日出约50~70ml。术后第13d发现切口有淡黄色液体渗出,有臭味,考虑肠瘘并胸腔相通感染。术后第17d在硬膜外麻醉下行第2次手术。升结肠造瘘术。术后每日给予补液、支持疗法、抗感染等处理,术后第49天诊断, Patient, male, 36 years old. Due to repeated left upper abdominal pain for more than one year and an increase of 3 days, it is proposed that “abdominal pain to be investigated” be paid to our hospital. Past history of pain in the left upper quadrant. Clear mind, weight loss, bloating, abdominal muscle tension, full abdominal tenderness (+), to the left upper abdomen as even, shifting dullness (++), bowel sounds hyperthyroidism, gas over water sound. Chest radiographs did not show abnormalities; the abdomen showed flat plateaus. Diagnosis: tuberculous peritonitis, intestinal obstruction. After 10 days of internal medicine treatment, no improvement was seen. Abdominal pain, bloating, and vomiting were noticeable. The proposed “intestinal obstruction” was transferred to the external second department, followed by laparotomy under epidural anesthesia. During the operation, the small intestine, transverse colon, and ascending colon were highly expanded. The descending colon and sigmoid colon were empty. There was a mass in the spleen of the colon and the tail of the pancreas. The spleen, stomach, and left iliac muscles adhered closely to form large lumps. The lumps adhered to the large curvature and posterior wall of the stomach and communicated with the stomach cavity (dissected after tumor resection). The left iliac surface was changed in a granular manner. The liver and gallbladder were not seen. abnormal. A partial resection of the left temporal muscle, a gastrojejunostomy, and an end-to-end anastomosis of the colon (closed drainage of the left chest tube and drainage of the upper abdominal tube) were performed. After the tumor was removed, the proximal end of the colon was decompressed and inserted into the urinary catheter. A large volume of saline and 0.7% metronidazole were used to wash repeatedly. 1820 ml of blood was transfused and 600 ml was infused. On the seventh day postoperatively, the chest radiograph showed a small amount of effusion in the left thoracic cavity, 2/3 of the pressure in the left lung, and 750 ml of suction in the thoracic cavity. About 100 ml of pale yellow liquid was elicited in the thoracic cavity and about 50 to 70 ml in the abdominal cavity. On the 13th day after the operation, the light yellow liquid leaked from the incision and there was an odor. Intestinal fistula and thoracic cavity infection were considered. On the 17th day after surgery, the second operation was performed under epidural anesthesia. Ascending colostomy. Postoperative fluid resuscitation, supportive therapy, and anti-infection treatment were performed daily, and the diagnosis was performed on the 49th day after operation.