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患者,55岁。因中下腹阵发性疼痛伴腹泻,消瘦1年,解暗红色血性大便1月,于1992年12月2日入院。入院前1年经常出现中下腹阵发性疼痛,每次发作经肌注硫酸阿托品后缓解。以后腹痛发作频繁,解粘液泡沫样大便,食欲逐日减退,气乏、消瘦。疑诊为“慢性结肠炎”,经中西药治疗病情不缓解。1月前腹痛加剧,腹胀伴呕吐,大便呈粘液暗红色。 查体:贫血貌,极度消瘦全腹稍膨隆,中下腹压痛,无肌紧及反跳痛,肠鸣音亢进,大便腹血试验(+)。按“慢性溃疡性结肠炎”应用中西药治疗无效,腹胀加重,腹痛转为持续性,呕吐频繁。呕吐物咖啡色样,持续中等度发热。入院后半月,因病情加重,体温高达39.8℃,WBC2.5×10~9/L,中性82％,腹胀明显,全腹膨隆,压痛(++),反跳痛(+),以中下腹最明显,移动性浊音(+),肠鸣音消失,左下腹穿刺抽出暗红色血性液体。考虑肠坏死,转外科,立即行剖腹探查术,见腹腔内有暗红色血性液体约1200毫升,除距Treitz韧带下50cm空肠,回音部上30cm回肠外,其余间小肠均紫黑色,肠
The patient is 55 years old. Due to paroxysmal pain in the lower abdomen with diarrhea, weight loss for 1 year, resolution of dark red bloody stools in January, was admitted on December 2, 1992. One year before admission, paroxysmal pain in the lower abdomen often occurred, and each episode was relieved by intramuscular injection of atropine sulfate. Afterwards, episodes of abdominal pain are frequent, and defoaming sputum-like bowel movements, loss of appetite, gas loss, and weight loss occur daily. Suspected as “chronic colitis”, the condition is not relieved by Chinese and Western medicine. 1 month ago, abdominal pain intensified, abdominal distension and vomiting, and mucous dark red stool. Physical examination: anaemia appearance, extreme weight loss, full abdominal bulging, mid-low abdominal tenderness, no muscle tightening and rebound tenderness, hyperactive bowel sounds, stool blood test (+). According to the “Chronic Ulcerative Colitis” application of Western medicine treatment is invalid, abdominal distension increases, abdominal pain becomes persistent, frequent vomiting. Vomiting coffee color, sustained moderate fever. Half a month after admission, he became ill with a heightened body temperature of 39.8°C, WBC 2.5×10-9/L, neutrality 82%, abdominal distention, full abdominal distention, tenderness (++), rebound tenderness (+), and The most obvious lower abdomen, mobile dullness (+), bowel sounds disappeared, the left lower abdomen puncture draw dark red bloody fluid. Consider bowel necrosis, transfer surgery, and immediately undergo exploratory laparotomy. See approximately 1,200 ml of dark red bloody fluid in the abdominal cavity, except for the jejunum of 50 cm from the Treitz ligament and the 30 cm ileum above the echo, the rest of the small intestine is purple-black.