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患者,女,74岁,因上腹胀痛,恶心、呕吐4天于1997年8月20日入院。呕吐物先为胃内容物,后为胆汁6～7次/d约500～700 ml。有萎缩性胆囊炎、胆结石史。查体:腹部饱满,上腹部压痛明显,胃区有震水音。化验:血WBC14.5×10~9/L,N0.79,γ-GT325u,ΛLT60u,TBiL35μmol/L。入院后B超见胆囊区有一6.1×3.9 cm不均质强回声,后方伴声影,考虑胆结石,不排除胆囊实性占位病变。5天后胃镜检查见十二指肠降部有胆汁潴留无法观察。行上消化道泛影葡胺造影示十二指肠水平段有一4.6×1.6 cm高密度影。诊断:小肠梗阻。给禁食、胃肠减压、补液、抗感染治疗无效,间断出现胃型。8月30日腹痛加重、呕吐剧烈,给肌注胃复安10 mg。5小时后由大便
The patient, female, 74 years old, was admitted to hospital on August 20, 1997 due to abdominal pain, nausea and vomiting for 4 days. Vomit first stomach content, after bile 6 ~ 7 times / d about 500 ~ 700 ml. Atrophic cholecystitis, gallstones history. Physical examination: full abdomen, tenderness on the abdomen, stomach vibration sound. Assay: blood WBC14.5 × 10 ~ 9 / L, N0.79, γ-GT325u, ΛLT60u, TBiL35μmol / L. B admitted to the hospital after the gallbladder area has a 6.1 × 3.9 cm heterogeneous strong echo, with sound shadow at the back, consider gallstones, does not rule out the gallbladder solid lesions. Gastroscopy after 5 days see duodenal descending bile retention can not be observed. Upper gastrointestinal tract meglumine diaphragmatic angiography showed a level of 4.6 × 1.6 cm high duodenal shadow. Diagnosis: Small bowel obstruction. To fasting, gastrointestinal decompression, rehydration, anti-infective therapy ineffective, intermittent gastric type. August 30 aggravating abdominal pain, severe vomiting, intramuscular injection of metoclopramide 10 mg. After 5 hours by stool