An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department with a 3-day history of constipation and lower abdominal pain. Physical examination was notable for abdominal distention and tenderness to palpation of the right lower quadrant without rebound or guarding. A plain radiograph of the abdomen is shown. What is the most likely diagnosis?
一名患慢性肾脏病、高血压和心房颤动的87岁男性因便秘和下腹痛3日到急诊科就诊。体格检查发现腹胀,右下腹触诊有压痛,无反跳或神经紧张。腹部平片显示。最有可能的诊断是什么?
A. Cecal volvulus 盲肠扭转
B. Constipation 便秘
C. Hiatal hernia 食管裂孔疝
D. Ogilvie’s Syndrome (acute colonic pseudo-obstruction) 欧吉维综合征(急性结肠假性梗阻)
E. Small bowel obstruction 小肠梗阻
答案解析:
腹部x线平片显示一种类似咖啡豆的充满空气的大肠袢,这一发现可能见于盲肠或乙状结肠扭转。患者就诊的偏远岛屿医院无法进行腹部计算机断层扫描。他被紧急送往手术室,发现了无肠道损伤体征的盲肠扭转,并成功复位。由于术中血流动力学不稳定,采用盲肠固定术和盲肠吻合术,而不是回盲部切除术或右半结肠切除术。患者的术后过程无并发症。随访6个月时,患者恢复良好,拒绝行造口逆转术。
正确答案:A
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