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病人男,47岁,因腹部疼痛月余加重并腹胀5天入院。有柏油样便,按阑尾炎、肠梗阻治疗无效。查体:呈恶液质,浅表淋巴结无肿大,下腹部膨隆,下腹肌紧张、压痛、反跳痛,未触及明显包块,腹水征(±),肠鸣音活跃,可闻及气过水音。辅助检查:钡灌肠阴性;腹部CT检查示肠梗阻、腹水;上消化道钡餐示小肠肿瘤。临床诊断:肠梗阻、小肠肿瘤?硬膜外麻醉下剖腹探查:腹腔有少量混浊渗出液,距屈氏韧带10cm空肠处有巨大憩室(长25cm,直径8.2cm),占据下腹部,内有大量混浊黑色液体,边缘质硬、脆,呈烂鱼肉样,浸透浆膜层累及膀胱底部和乙状结肠系膜,未见肿大淋巴结,钝性剥离与膀胱和乙状结肠系膜的粘连,行憩室和部分空肠切除(远近端分别距憩室5cm),术后恢复尚顺利,痊愈出院。病理报告为小肠憩室(巨大)恶变。镜检见癌细胞形成大小不等、形状不一、排列不规则的腺管状结构,其间有少量间质存在,诊断:小肠憩室腺癌。随访病人至今恢复好。 讨论 小肠憩室多见于距回盲瓣约45～90cm的回肠
The patient male, 47 years old, was admitted for hospitalization for 5 days after abdominal pain for more than a month. With tarry stools, treatment for appendicitis and intestinal obstruction was ineffective. Physical examination: showing dystrophy, no enlargement of superficial lymph nodes, distention of lower abdomen, tension of lower abdominal muscles, tenderness, rebound tenderness, unobstructed mass, ascites sign (±), active bowel sounds, audible air Over water sounds. Auxiliary examination: barium enema negative; abdomen CT examination showed intestinal obstruction, ascites; upper gastrointestinal barium meal showed small intestine tumors. Clinical diagnosis: intestinal obstruction, small intestine tumor? Epidural anesthesia under laparotomy: a small amount of turbid fluid in the abdominal cavity, 10cm from the triceps ligament at the jejunum with a huge diverticulum (length 25cm, diameter 8.2cm), occupy the lower abdomen, there are A large amount of turbid black liquid, hard and brittle edge, rotten fish-like, immersed in the serosa layer involving the bottom of the bladder and sigmoid mesentery, no enlarged lymph nodes, blunt dissection and adhesion of the bladder and sigmoid mesentery, line diverticulum and part Jejunal resection (distal and proximal 5 cm from the diverticulum), postoperative recovery was still successful, cured and discharged. The pathology report was malignant (large) malignant changes in the small intestine. Microscopic examination revealed that cancer cells formed irregularly shaped, irregularly arranged and irregularly arranged glandular tubular structures with a small amount of interstitial substance present. Diagnosis: Small intestine diverticulum adenocarcinoma. Follow-up patients have recovered so far. DISCUSSION Small intestine diverticulum is more common in the ileum of approximately 45 to 90 cm from the ileocecal valve