每日一题_2024.08.16

A 61-year-old woman presented to the emergency department with a 2-day history of dull, intermittent lower abdominal pain. She reported no vomiting, diarrhea, bloody stools, or hematuria. The vital signs were normal with the exception of the blood pressure, which was 174/107 mm Hg. On physical examination, tenderness was present in the left lower abdomen without rebound or guarding. The white-cell count and C-reactive protein level were normal. Computed tomography of the abdomen showed an ovoid lesion adjacent to the descending colon with ring enhancement, density of fat, and surrounding fat stranding. What is the most appropriate initial management?

一位61岁女性因下腹部钝痛间歇性发作2天而到急诊科就诊。她报告没有呕吐、腹泻、血便或血尿。生命体征正常，除了血压为174/107毫米汞柱。体格检查发现左下腹部有压痛，但没有反跳痛或防卫。白细胞计数和C反应蛋白水平正常。腹部计算机断层扫描显示降结肠旁有一个卵形病变，有环状增强、脂肪密度和周围脂肪条索影。最合适的初步管理是什么？

A. Analgesia only仅镇痛

B. Elective surgical removal选择性手术切除

C. Intravenous antibacterial agents静脉抗菌药物

D. Percutaneous needle biopsy经皮穿刺活检

E. Urgent surgical removal紧急手术切除

答案解析：

确诊为急性上皮样附属物炎。上皮样附属物是结肠上的小囊状突起，内含脂肪和小血管。当这些突起因扭转或血栓形成而发生缺血时，就会导致急性上皮样附属物炎。这种病状是良性的，并且自行限制病程。在这个案例中，医生开了口服对乙酰氨基酚的处方；10天后，患者的症状有所缓解。

正确答案：A