42-year-old man, Mr. Zhou (pseudonym), suddenly suffered abdominal pain without any obvious cause.
Abdominal pain
Before the onset, there was no discomfort, and everything was normal for eating, sleeping, and defecation. At first, Mr. Zhou didn't care when he had abdominal pain, but after an hour, the abdominal pain made Mr. Zhou unable to straighten his back, so he came to the hospital.
After physical examination, abdominal pain was mainly concentrated around the navel. No tenderness, no rebound pain, and the rest of the abdomen are normal. After the onset, there was no nausea, vomiting, diarrhea, fearless chills, fever, no chest tightness, , chest pain, , palpitations, , shortness of breath, no urinary tract stimulation symptoms.
EKG, blood pressure, etc. are normal. Vital signs are very stable.
In other words, the patient has pain around the navel and there is no other problem.
But the doctor did not despise it because in the doctor's opinion, seemingly simple abdominal pain often hides huge hidden dangers. So the man was arranged to undergo a regular blood test, blood amylase, and abdominal flat film examination, mainly to rule out pancreatitis , gastroenteritis , intestinal obstruction and other diseases. When the
test results came out, except for a small amount of gas accumulation in the colon, the rest were normal.
Such a simple medical history and such a simple sign make the doctor difficult. What I fear most is that this sign is very obvious, but the test results are completely normal, because there are too many causes of abdominal pain, but no test results can confirm which disease it is.
B ultrasound examination
According to the hospital's routine abdominal pain diagnosis and treatment process, the first thing that needs to be excreted after abdominal pain is found is life-threatening vascular diseases and cardiogenic diseases, such as aortic dissection , myocardial infarction, acute pericardial tamponade, mesenteric embolism, etc. Since the patient's ECG, blood pressure and other vital signs are normal, cardiogenic diseases can basically be ruled out, but abdominal aortic dissection, abdominal aortic aneurysm, , etc. cannot be ruled out, but no abnormalities were found in the abdominal flat film examination.
According to the physiological anatomy, the organs around the navel are nothing more than the ileum, mesenteria, etc. The sudden periumal pain in the patient is a sudden disease of the ileum and mesenteria?
had no choice but to stay in the hospital for observation. At this time, what needs to be observed is whether abdominal pain has metastasized and whether new important signs will occur.
Soon, when I was in the hospital for 36 hours of observation, the doctor checked again and found an important clue: a lump could be touched in the middle of the man's lower abdomen, which was soft to the touch, with clear boundaries, and could be pushed with hands, and there was light tenderness. The auscultation found that the intestinal rumbling sound was active.
The middle part of the lower abdomen? It feels soft to the touch?
The doctor initially suspected that it was a swollen bladder. Could it be urinary retention ?
Then catheterization was performed. However, after more than 300 ml of catheterization, the lump still existed after palpation. This way, the enlarged bladder was ruled out.
had no choice but to puncture the abdominal mass, and as a result, a needle was pricked and sucked out about 30ml of bloody liquid!
Abdominal puncture
New mass is located in the middle of the lower abdomen and hemorrhagic fluid is drawn. Is it a new hematoma?
Which part of the hematoma occurred? These questions were placed before the doctor.
Since it has been more than 36 hours since the onset of the disease and the cause of abdominal pain is unknown, hemorrhagic fluid is drawn, and a laparotomy is urgently needed. After obtaining the patient's consent, an emergency laparotomy was found in the patient's intestinal loop. The intestinal loop was flatulent, and the purple-black intestinal loop could be seen in the patient's left upper abdomen. It seemed that it had ischemia and necrosis had occurred.
open surgery
manual cleaning, and found that the intestinal loop had been twisted by 360°-540°. After straightening it, I found that it turned out to be intestinal intussusception . Moreover, the intestinal segments that are inserted are longer, and mesenteric is also inserted.
The doctors secretly thanked that they conducted a laparotomy in time, otherwise the delay in the condition would likely cause more serious intestinal necrosis , which eventually leads to serious infection or even death.
The so-called intussusception means that part of the intestinal duct and mesenteria are inserted into the adjacent intestinal duct, just like a cup is placed in a cup.Instussusception is generally prone to intestinal affinity in children and is rare in adults.
After intussusception occurs, typical symptoms are abdominal pain, abdominal lumps and bloody stools.
Intestinal instussusception
Most of the reason for intestinal instussusception is due to intestinal malformation (Meker diverticulum, a congenital intestinal malformation), intestinal polyps , intestinal tumor , etc., causing intestinal peristalsis rhythm to dysregulate. The strong peristalsis of the proximal intestinal duct will send the lesion together with the intestinal duct to the distal intestinal duct at the same time.
After finding that the patient had intussusception, he tried to recover manually, but found that it was difficult to recover, so he performed intussusception segment removal, with a mild port. After the operation, it was found that there was a large polyp in the intestinal cavity at the head end of the enclosure, with a diameter of about 1.0 cm.
soon after pathology was confirmed as intestinal ischemia necrosis and intestinal intestinal intestinal.
I have to say that there are too many causes of abdominal pain, and many times you cannot judge by intuition alone. Just imagine if the patient's illness is simple and the doctor thinks it is simple gastroenteritis or urinary retention treatment, the consequences will be unimaginable.
