六十歲男性,主訴腹脹一天...
過去有過闌尾炎手術的病史,
從昨晚晚餐後就一直脹到隔天晚上...
但是還有放屁與一點點大便...
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPwvKaIZ8lstfzSANzIDruuWXTHuKCdAKMr6yk6NMlP8rQDRteQrDVyax_duaV0AmmLLpnDTqSZbaE5iNtVivaDBblp80T40ARuXRIM6ezJ_jdMXZdBp2fXrx2aioAst56DJsqTKVJu70N/s1600/1338205715.jpg)
一看到這個胃就覺得有問題了...
禁食一天的病人不應該脹成這樣...
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiJY3Lag1Rn78b8kWMK0qnmlF8BAN8j0Rd40YLS8pSVXOiE-JrA_LfvzXLODxAl-ILedF3NxqSJGeaML-BaUHUbC8MbKeKgFkOc110_sg8p7SvXnLcSoF67inrzPJJ_FuyRhVndj2Q8NsZ/s1600/1338205716.jpg)
看起來大腸還有空氣,應該不到完全塞死的程度...
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4tYxdWYk1vM8GeQMcz9qTzdi_eXKIa0n9i61-SvVp_yYvqOb8mHx2dJBI7wG_u6A0eCj4LGfHFJ8zKpTgetT0FyyQ-hi5AzSI7dPxRZLzQMREUkdvLfTVK_yyRpRR7BGzdgdH0BUURar3/s1600/1338205717.jpg)
但是小腸已經出現所謂的transition zone...
這不是好現象,代表中間有東西塞住了...
要自己解開的可能性不大...
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJU42QzaJ8Tc_hoyeNZS5ZBcowkowxQLK2uEG8DaQRD0h8A1AN0Fm49kwxN5uCxrvLq3KgaAoSJHOQLJnU_XqnVllkxmyDYChcu2L7tZtV39bVChmyUsnCyhVTKBkjnuVckro_YZsGiJD/s1600/1338205718.jpg)
看到這張圖片,我已經有了要幫他開刀的準備...
只是小腸裡這坨東西究竟是什麼?
(絕大多數是食物殘楂形成的糞石)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLfKIhi7fYXF3OowJGHZZ78FzR02I1VyjkNgFzOv8HUI9S3rHkjc8Zh4lYhd4XvExGAJ6mQMu_5ASEEzxBuF60AiQtzLdB3Na3IA0uDdKcBihmtaDLbtQlJnJSO9r1CNRDFzqX8UqifW1d/s1600/1338205719.jpg)
小腸壁開始變厚代表相當嚴重的發炎,
再加上已經出現腹水...
再不久可能就要腹膜炎了!!
於是Peter Fu做了開刀的建議...
答案將在下一篇揭曉...
吊人胃口....
回覆刪除雖然看不懂圖片但是我還是認真看完了..結果
回覆刪除是什麼???
small bowel obstruction, likely resulted from fecalith
回覆刪除impaction. DDx: trichotillosis although it is mostly found in
younger and female patient.
and of course, adhesive ileus should be placed as the first
回覆刪除diagnosis after all.