腹腔内结石误诊为胆总管结石一例

Abdominal Intracavitary Calculi Misdiagnosed as Common Bile Duct Calculi: a Case Report

目的探讨腹腔内结石的临床特征及误诊原因。方法回顾性分析我院近期收治的误诊为胆总管结石的腹腔内结石1例的临床资料。结果本例因右上腹痛1月余入院。曾就诊当地医院,诊断为胆总管结石,予对症治疗后症状稍好转,但仍反复发作。入院后行血常规、肝功能、腹部CT等检查并于气管插管全身麻醉下行腹腔镜探查术,术后结合组织病理检查结果,确诊为腹腔内结石并感染、慢性胆囊炎,予抗感染等治疗后好转出院。随访10个月,未出现相关并发症。结论临床遇及右上腹痛且予对症治疗后症状未见缓解者,要考虑到腹腔内结石的可能,完善相关检查是避免或减少误诊误治的关键。

Objective To investigate clinical features and misdiagnosed causes of abdominal intracavitary calculi. Methods Clinical data of one patient with abdominal intracavitary calculi, who was misdiagnosed as having common bile duct calculi, was retrospectively analyzed. Results The patient was admitted for pain in right hypochondrial region for more than one month. The patient was misdiagnosed as having common bile duct calculi in local hospital, and patient＇s symptoms had be improved a little after symptomatic treatment, but the condition was recurrent. After admitting in our hospital, examinations such as blood routine, liver function, computed tomography （ CT） scan for abdomen and laparoscopic approach surgery under tracheal cannula and intubation anesthesia were performed, and the patient was confirmed as having abdominal intracavitary calculi combined with infection and chronic cholecystitis according to histopathologic result. The patient was discharged after condition had been improved by anti-infectious therapy. No related complication was found with 10 months of follow-up. Con-clusion Clinicians should take into account the possible of abdominal intracavitary calculi for patients with pain in right hypo-chondrial region without remission by symptomatic treatment. Related examinations should be performed completely in order to avoid misdiagnosis and mistreatment.