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病例6-2016:一名腹部痉挛和发热的10岁男童
Case 6-2016 — A 10-Year-Old Boy with Abdominal Cramping and Fevers


Jeffrey A. Biller ... 肿瘤 围产医学和儿科 • 2016.02.25

10岁男孩腹痛伴发热,为何诊断结肠腺癌

 

陈倩

北京大学第一医院妇产科

 

10岁男孩间断腹痛伴发热,面对这样的病例,临床医生首先想到的可能诊断会是什么?2016年《新英格兰医学杂志》(NEJM)发表了一则这样的病例,最终诊断结果有些出人意料1

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病历陈述


Hasan Merali医师(儿科):一名10岁男童由于腹部间歇性痉挛和发热前来本院胃肠病门诊就诊。

患者此前健康状况正常。本次就诊前约3周间歇性发热至39.7 ℃,之后腹部脐周和脐下区域有痉挛发作,无呕吐。每日排便1~2次;大便成形,出现过一两次便血。据称他已有2周半时间不能上学。此次就诊前2日,他曾在另一家医院的急诊科就诊。血液电解质、葡萄糖、白蛋白、淀粉酶、脂肪酶和尿素氮水平均正常,尿液分析和肝功能检查结果也正常。乳糜泻和EB病毒感染的筛查试验为阴性;其他检查结果在表1中列出。





作者信息

Jeffrey A. Biller, M.D., S. Reha Butros, M.D., Gayun Chan-Smutko, M.S., Annah N. Abrams, M.D., Daniel C. Chung, M.D., and Catherine E. Hagen, M.D.
From the Departments of Pediatrics (J.A.B.), Radiology (S.R.B.), Psychiatry (A.N.A.), Medicine (D.C.C.), and Pathology (C.E.H.) and the Cancer Center (G.C.-S., D.C.C.), Massachusetts General Hospital, and the Departments of Pediatrics (J.A.B.), Radiology (S.R.B.), Psychiatry (A.N.A.), Medicine (D.C.C.), and Pathology (C.E.H.), Harvard Medical School — both in Boston.

 

参考文献

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