围术期隐匿型膀胱肠道瘘1例并文献复习

Perioperative occult bladder intestinal fistula:a case report and literature review

目的:隐匿型膀胱肠道瘘不易被发现,临床上容易漏诊误诊,医务人员需提高对它的认识,以求早诊断早治疗。方法:回顾性分析1例隐匿型膀胱肠道瘘的临床资料,并结合文献综合分析讨论其病因学、诊断、临床表现及治疗。结果:隐匿型膀胱肠道瘘在行膀胱镜时可用输尿管导管试插瘘口可疑部位,再注入适量造影剂,然后摄片,如造影剂进入肠腔即可确诊。在治疗上手术为首选,切除病变肠管,严重者需行膀胱修补术。结论:CT结合膀胱镜虽是确诊膀胱肠道瘘的首选检查,但结合临床表现及病史综合考虑仍至关重要。

Objective Occult bladder intestinal fistula is not easy to be found,and it is easy to be missed and misdiagnosed clinically.Medical personnel need to improve their understanding on it in order to make early diagnosis and treatment.Methods The clinical data of a case of occult bladder intestinal fistula was retrospectively analyzed,and the etiology,diagnosis,clinical manifestations,and treatment were discussed in combination with literature analysis.Results Occult bladder intestinal fistula could be diagnosed by inserting ureter catheter into the suspected site of fistula,injecting appropriate amount of contrast agent,and then taking radiography,confirmed by contrast agent entering intestinal cavity.Surgery was the first choice for treatment,the resection of the diseased intestinal canal was required,and bladder repair was required for severe cases.Conclusion CT combined with cystoscopy is the first choice for the diagnosis of bladder intestinal fistula,but it is still very important to consider the clinical manifestations and medical history comprehensively.