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患者50岁。因全子宫切除术后15d,腹痛呕吐3d,于1998年9月6日入院。患者于1998年8月21日因“子宫肌瘤”在本院行全子宫切除术,术后恢复良好,于8月30日痊愈出院。9月3日开始出现腹痛,呈阵发性,尤以左下腹为甚,伴呕吐、腹胀、不排气、不排便、轻度发热。经肌注青霉素等治疗无效再次入院。查体:T36.4 ℃, P84次/min,BP18/12kPa。急性痛苦病容。心肺无异常。腿轻度膨隆,全腹压痛,反跳痛及肌紧张不明显。腹水征阴性,肠鸣音弱。妇科检查未见异常。腹部X线平片见腹腔内有数个气液平面。B超见肠管扩张,肠壁增厚,腔内可见点片状回声及肠液往返蠕动,提示肠梗阻。化验Hb107g/L,WBC12.1×10~9/L,N0.78,L0.22。K~+3.98mmol/L,Na~+139.4mmol/L,Cl~-99.9mmol/L。尿化验正常。入院诊断:肠梗阻(炎性)。给以禁食,胃肠减压,氨苄青霉素4.0静注3次/日,及输液等支持对症治疗。9月9日腹痛减轻,9月10日肠鸣音正常,肛门排气并排大便。共住院8d痊愈出院。 讨论 术后早期炎性肠梗阻(Early postoperative
The patient is 50 years old. Due to hysterectomy 15d, abdominal pain and vomiting 3d, on September 6, 1998 admission. Patients on August 21, 1998 due to “uterine fibroids” in our hospital hysterectomy, postoperative recovery was good, was discharged on August 30. September 3 began to appear abdominal pain, paroxysmal, especially in the lower left abdomen, with vomiting, bloating, no exhaust, no defecation, mild fever. After myopathy penicillin treatment invalid again hospitalized. Physical examination: T36.4 ℃, P84 times / min, BP18 / 12kPa. Acute pain and sickness. No abnormal heart and lung. Legs slightly bulging, full abdominal tenderness, rebound tenderness and muscle tension is not obvious. Ascites sign negative, bowel sounds weak. No abnormal gynecological examination. Abdominal X-ray see the abdominal cavity has several gas-liquid level. B super-see intestinal dilation, thickening of the intestinal wall, the cavity can be seen echogenic and intestinal fluid reciprocation, suggesting intestinal obstruction. Assay Hb107g / L, WBC12.1 × 10 ~ 9 / L, N0.78, L0.22. K ~ + 3.98mmol / L, Na ~ + 139.4mmol / L, Cl ~ -99.9mmol / L. Urinalysis is normal. Admission diagnosis: intestinal obstruction (inflammatory). Give fasting, gastrointestinal decompression, ampicillin 4.0 intravenous 3 times / day, and infusion support symptomatic treatment. Abdominal pain on September 9 to reduce, September 10 normal bowel sounds, anal exhaust side by side stool. A total of 8d hospital discharged. Early postoperative inflammatory bowel obstruction (Early postoperative