肠石性肠梗阻误诊分析：附病例报告

Misdiagnosis of Enterolith Ileus: Case Report

本文回顾性分析了2012—2013年本院诊治的2例肠石性肠梗阻患者的临床资料,旨在提高对此病的临床认识,以减少误诊。患者1初步诊断为腹腔血管病变或急性胰腺炎,经住院观察和检查后又考虑为回肠末端炎症性病变:克罗恩病或肠套叠,治疗后症状好转出院,最终未明确诊断。出院2个月后症状再次加重住院,最终通过手术明确诊断。患者2有2次腹部手术史,诊断为粘连性肠梗阻,保守治疗6 d,梗阻未缓解,经手术证实为肠石所致。肠石性肠梗阻临床表现多不典型,临床医生对其CT、MRI的特征性影像学表现不熟悉,易延误诊治。

This study analyzed two cases of enterolith ileus between 2012 and 2013 retrospectively, in order to improve the clinical awareness of the disease and reduce misdiagnosis. Patient 1 with an initial diagnosis of abdominal vascular disease or acute pancreatitis, was admitted in the hospital, after the observation in hospital and further examination, the diagnosis was changed to terminal ileum inflammatory disease Crohn＇s disease or intussusception. After treatment, the patient was dis- charged with the reduced symptoms but still without a definite diagnosis. After two months, the symptoms became more severe and the patient was hospitalized again. The clear diagnosis of enterolith ileus was eventually made after surgery. Patient 2 with two abdominal surgeries in the past was diagnosed with intestinal obstruction. After six days of the conservative treatment, the ob- struction was not relieved, which was proved to be caused by enterolith after surgery. The atypical clinical manifestations of en- terolith ileus along with the doctor＇s limited knowledge of its CT and MRI imaging characteristics made the diagnosis more diffi- cult, which might delay the treatment.