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患者,41岁。酒后被他人拳脚猛击腹部及全身。当时腹痛剧烈,立即就近送本市医院,以“腹膜炎”行剖腹探查,术中证实膀胱体前壁破裂穿孔,行穿孔修补术,清理腹腔,探查小肠及系膜敢在性血瘀点。术后4日,腹胀、腹痛剧烈伴忍心呕吐转入本院普外科。以“粘连性肠梗阻”保守治疗无效行第2次剖腹手术。术中见小肠、膀胱与腹膜、大网膜均有广泛粘连,松解粘连后,使肠道通畅。术后禁食,胃肠减压5天,肛门排气排便,无腹胀随进食,8日拆线,切口甲级愈合,病人及家属要求院后休息治疗。出院第9天,腹胀、阵发性腹痛,肛门停止排气排便再次入院。体检面色淡白,形体消瘦,Bp 12/7.8kPa,腹胀,见肠型压痛(+),肌卫明显,听诊可闻及气过水声,腹平片见多枚气液平。第3次剖腹,术中见整个小肠广泛粘连成角,以回肠段为甚。肠管高度胀气,无法完全松解,随切除大部分回肠段,空回肠端端吻合,术后1周,腹胀症状又出现,病人此时已极度衰竭,形体消瘦,体重由第2次手术前的62kg下降至49kg,血常规Hb110g/L,RBC 3.5×10~(12)/L,WBC 4.2×10~9/L,N0.56。血生化检查,BUN 2.0mmol/L,非蛋白氮(NPN)14mmol/L,总蛋白50g/L,K~+3.0mmol/L,Ca~(2+)2.0mmol/L,葡萄糖4.0mmol/L;腹穿抽出淡黄
Patient, 41 years old. Drunk by his fist punching the abdomen and body. Severe abdominal pain immediately sent to the city hospital to “peritonitis” laparotomy exploration, intraoperative confirmed anterior bladder wall rupture perforation, perforation repair, clear the abdominal cavity, probing the small intestine and mesangial dying in the blood stasis. 4 days after surgery, abdominal distension, severe abdominal pain with heart and vomiting transferred to our hospital general surgery. Conservative treatment of “adhesive intestinal obstruction” was ineffective in the second laparotomy. Surgery, see the small intestine, bladder and peritoneum, omentum have a wide range of adhesions, release adhesions, so that intestinal patency. Postoperative fasting, gastrointestinal decompression 5 days, anal defecation, no abdominal distension with eating, suture removal on the 8th, incision grade healed, patients and their families required rest after hospital treatment. Discharged 9 days, abdominal distension, paroxysmal abdominal pain, anus to stop the exhaust defecation again hospitalized. Physical examination pale, body weight loss, Bp 12 / 7.8kPa, abdominal distension, see intestinal type tenderness (+), Myung Wei obvious auscultation and gas over the water can be heard, abdominal plain film see more than one gas level. The third Caesarean section, intraoperative see the entire small intestine extensive adhesions into the corner, to the ileum is staggering. Intestinal flatulence, can not completely release, with the removal of most of the ileum segment, ileum end anastomosis, 1 week after surgery, bloating symptoms appear, the patient has been extremely depleted at this time, body weight loss, body weight from the second preoperative 62kg down to 49kg, blood routine Hb110g / L, RBC 3.5 × 10-12 / L, WBC 4.2 × 10-9 / L, N0.56. Blood biochemical tests showed that BUN 2.0 mmol / L, NPN 14 mmol / L, total protein 50 g / L, K ~ + 3.0 mmol / L, Ca 2+ 2.0 mmol / L, glucose 4.0 mmol / L Abdominal wear out of light yellow