1临床资料 患者女，55岁，因“腹泻2 d，剧烈腹痛10 h，渐加剧”，于2011年11月7日入院。查体：T 37.2℃， P 100次/ min，R 21次/ min，Bp 114/64 mmHg，急性痛苦面容，曲腹体位，全腹明显压痛、反跳痛，肌紧张，以上腹及左上腹为著。X...1临床资料 患者女，55岁，因“腹泻2 d，剧烈腹痛10 h，渐加剧”，于2011年11月7日入院。查体：T 37.2℃， P 100次/ min，R 21次/ min，Bp 114/64 mmHg，急性痛苦面容，曲腹体位，全腹明显压痛、反跳痛，肌紧张，以上腹及左上腹为著。X 线：腹部立位片未见异常。腹部 B 超：子宫后方探及范围约30 mm ×17 mm 不规则无回声区，右下腹肠间探及范围约23 mm ×19 mm 的不规则无回声区。于当日在全麻下行剖腹探查术，术中见：淡黄色腹腔积液约800 mL，肝肾隐窝及脾肾隐窝处积液较黏稠，降结肠距脾曲5 cm 处有一长约5 cm、直径约2 cm 大小憩室，表面充血水肿，顶端有一约0.5 cm 穿孔，腔内积存椭圆形鸽卵大小粪石2枚，进一步探查，肠腔内无粪便残留，遂切除憩室，Ⅰ期横行缝合结肠壁，充分冲洗腹腔，分别留置腹腔引流及肛管，术后恢复顺利，住院10 d 出院。病理：（降结肠憩室）肠壁全层可见较多急慢性炎细胞浸润，部分可见坏死。结果：治愈，随访2年无不适。展开更多
Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has...Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.展开更多
文摘1临床资料 患者女，55岁，因“腹泻2 d，剧烈腹痛10 h，渐加剧”，于2011年11月7日入院。查体：T 37.2℃， P 100次/ min，R 21次/ min，Bp 114/64 mmHg，急性痛苦面容，曲腹体位，全腹明显压痛、反跳痛，肌紧张，以上腹及左上腹为著。X 线：腹部立位片未见异常。腹部 B 超：子宫后方探及范围约30 mm ×17 mm 不规则无回声区，右下腹肠间探及范围约23 mm ×19 mm 的不规则无回声区。于当日在全麻下行剖腹探查术，术中见：淡黄色腹腔积液约800 mL，肝肾隐窝及脾肾隐窝处积液较黏稠，降结肠距脾曲5 cm 处有一长约5 cm、直径约2 cm 大小憩室，表面充血水肿，顶端有一约0.5 cm 穿孔，腔内积存椭圆形鸽卵大小粪石2枚，进一步探查，肠腔内无粪便残留，遂切除憩室，Ⅰ期横行缝合结肠壁，充分冲洗腹腔，分别留置腹腔引流及肛管，术后恢复顺利，住院10 d 出院。病理：（降结肠憩室）肠壁全层可见较多急慢性炎细胞浸润，部分可见坏死。结果：治愈，随访2年无不适。
文摘Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.
