摘要
目的探讨右结肠憩室穿孔并腹腔脓肿形成的临床特点及误诊原因、防范措施。方法对曾误诊的11例右结肠憩室穿孔并腹腔脓肿形成的临床资料进行回顾性分析,并复习相关文献。结果11例均有右侧腹部胀痛,有转移性右下腹痛7例,存在不同程度肠梗阻5例。病程5 d^6个月。11例术前均未确诊,误诊为阑尾周围脓肿4例,误诊为结肠癌并穿孔和(或)肠梗阻7例。误诊时间5 d^6个月。入院后酌情给予胃肠减压、抗感染和静脉补液支持等对症处理,均急诊行常规剖腹探查或腹腔镜探查术,实施右半结肠切除7例、回盲部切除2例、单纯腹腔脓肿引流2例,术后常规病理检查明确诊断为右结肠憩室穿孔并腹腔脓肿形成。术后发生吻合口瘘1例、腹壁切口感染3例,给予相应处理后均痊愈。随访1~2年,2例因心脑血管意外病故,余健在。结论结肠憩室穿孔并腹腔脓肿形成属于复杂性憩室炎,临床表现缺乏特异性,易误诊。腹部螺旋CT并多平面重建以及腹腔镜探查术对该病诊治具有重要临床价值。右结肠憩室穿孔并腹腔脓肿形成可实施一期手术,术后并发症相对较少,预后好。
Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of right-sided colonic diverticulum perforation with abdominal abscess formation.Methods The clinical data of 11 cases of right-sided colonic diverticulum perforation with abdominal abscess formation in our hospital were retrospectively analyzed,and the related literature was reviewed.Results All the 11 cases had right abdominal distension,7 cases had metastatic right lower abdominal pain and 5 cases had different degree of ileus.The duration from the first onset to the last visit was 5 d-6 months.None of the 11 cases were diagnosed preoperatively,4 cases were misdiagnosed as periappendiceal abscess,and 7 cases were misdiagnosed as colon cancer with perforation and/or ileus.The duration of misdiagnosis was 5 d-6 months.After admission,gastrointestinal decompression,anti-infection and intravenous fluid replacement therapy were given as appropriate.Routine exploratory laparotomy or laparoscopic exploratory laparotomy was performed in all patients.Intraoperative diagnosis was confirmed as colic diverticulum perforation with abdominal abscess formation.Subsequently,7 cases underwent right hemicolectomy,2 cases underwent ileocecal resection,and 2 cases underwent simple abdominal abscess drainage.Routine pathological examination after operation confirmed the diagnosis of right-sided colonic diverticulum perforation with abdominal abscess formation.Postoperative anastomotic fistula was found in 1 case and abdominal incision infection in 3 cases,which were cured after corresponding treatment.The patients were followed up for 1-2 years,2 cases died of cardiovascular and cerebrovascular accidents with the others healthy and alive.Conclusion Colonic diverticular perforation with abdominal abscess formation belongs to the complicated diverticulitis,while its clinical manifestation lacks specificity and it is easy to be misdiagnosed.Spiral CT and multi-plane reconstruction imaging of the abdomen and laparoscopy are of great cl
作者
朱金明
李翠芳
杨光
ZHU Jin-ming;LI Cui-fang;Yang Guang(Department of General Surgery,the 960th Hospital of PLA Joint Logistics Support Forces,Jinan 250031,China;Department of General Practice,the 960th Hospital of PLA Joint Logistics Support Forces,Jinan 250031,China)
出处
《临床误诊误治》
2020年第11期10-15,共6页
Clinical Misdiagnosis & Mistherapy
关键词
憩室
结肠
肠穿孔
脓肿
误诊
阑尾炎
结肠癌
Diverticulum,colon
Intestinal perforation
Abscess
Misdiagnosis
Appendicitis
Colonic neoplasms
