每日一题_2024.11.15

A previously healthy 18-month-old girl was brought to the emergency department with sudden-onset abdominal distention that had been preceded by 3 days of diarrhea and 1 day of vomiting. On physical examination, the patient appeared lethargic and dehydrated. The abdomen was markedly distended with decreased bowel sounds, but there was no tenderness or guarding. An abdominal radiograph, obtained with the patient in the supine position, showed three circular radiopaque objects in the intestines, along with dilated loops of bowel. What is the most appropriate next step in this case?

一名之前健康的18个月大女孩被带到急诊室，她突然出现腹部膨胀，此前有3天的腹泻和1天的呕吐。在体格检查中，患者显得倦怠和脱水。腹部明显膨胀，肠鸣音减少，但没有压痛或腹肌紧张。在仰卧位下进行的腹部X光片显示肠道中有三个体圆形的放射性不透明物体，以及扩张的肠环。在这种情况下，最合适的下一步是什么？

A. Colonoscopy retrieval结肠镜取出

B. exploratory laparotomy探查性开腹手术

C. Laxatives泻药

D. Observation and monitoring观察和监测

E. Serial imaging连续成像

答案解析：

由于担心摄入异物，进行了紧急探查性开腹手术。发现由三颗磁珠结合形成的回肠结肠瘘，同时注意到肠环扩张。移除了磁珠并对肠道进行了修复。诊断为小肠梗阻和由意外摄入磁铁引起的肠瘘。为了防止摄入磁铁引起的严重胃肠并发症，如组织坏死、瘘管形成、穿孔、肠扭转或梗阻，应将小磁铁放在儿童触及不到的地方。

正确答案：B