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病例8-2020:一名反复腹痛和便血的89岁男性
Case 8-2020 — An 89-Year-Old Man with Recurrent Abdominal Pain and Bloody Stools


Hacho B. Bohossian ... 其他 • 2020.03.12
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病例陈述


Emily W. Lopes医师:一名89岁男性因反复便血在本院接受了评估。

在此次评估前2年,患者接受了右腹股沟疝修补术。术后恢复后,患者有右下腹间歇性疼痛。在此次评估前4个月,患者出现弥漫性腹痛及之后的排便期间有晕厥先兆,因而被收入本院。此次检查中值得关注的结果包括双侧下腹部压痛,胸骨左缘可闻及递增递减型收缩期杂音(2/6级)。实验室检查结果见表1。

 

表1. 实验室检查数据*

* 将尿素氮值转换为mmol/L需乘以0.357。将肌酐值转换为μmol/L需乘以88.4。

† 参考值受许多变量的影响,包括患者人群和所用的实验室方法。麻省总医院使用的参考值范围是针对未妊娠,并且不存在能影响结果的身体状况的成人患者,因此可能并不适用于所有患者。

 

Lauren A. Roller医师:口服造影剂而非静脉注射造影剂后进行的腹部和盆腔计算机断层扫描(CT)(图1A和1B)显示降结肠和乙状结肠憩室病,并伴有降结肠远端局灶性充血和肠壁增厚。主动脉和主动脉分支有动脉粥样硬化性改变,并且有一个36 mm的肾下段主动脉瘤。胆囊和胆总管内可见不透射线的小结石。

 

图1. 第一次和第二次住院时腹部和盆腔CT图像

在此次评估前4个月(第一次住院),口服而非静脉注射造影剂后获取的冠状位图像(图A和图B)显示,降结肠远端的一小段有节段性肠壁增厚和肠系膜性改变,其中含有多个憩室(箭形)。在此次评估前2个月(第二次住院),静脉注射和口服造影剂后获取的轴位图像(图C)显示,乙状结肠和直肠有节段性肠壁增厚、黏膜增强和水肿,肠系膜血管充盈,且无相关憩室(箭形)。第一次住院期间观察到的降结肠远端肠壁增厚已经消退(箭头)。

 

Lopes医师:患者排出几次非血性稀便,腹痛减轻。医师开了口服环丙沙星和甲硝唑经验性治疗,患者于住院第3日出院。





作者信息

Hacho B. Bohossian, M.D., Emily W. Lopes, M.D., Lauren A. Roller, M.D., Ashwin N. Ananthakrishnan, M.D., M.P.H., and Lawrence R. Zukerberg, M.D.
From the Department of Medicine, Newton–Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston — all in Massachusetts.

 

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