论文部分内容阅读
患者,女,79岁。入院前1年因为便秘在某医院做纤维结肠镜检,只进18cm即受阻,除在15cm处发现一憩室外未见其他异常。1个月后改用加压钡灌肠检查全结肠,未能发现病变,并在检查过程中造成严重腹痛,且在检查后数日发现小包块,当地医院诊断为“腹股沟疝”并行“疝修补术”。术后不久发现尿色发黄且有臭味,又经多科多次检查未能发现病变。入院前半个月因尿有粪渣,腹痛,不能进食而转来我院。腹平片示小肠不全梗阻。妇科排除了阴道瘘而确定为膀胱直肠瘘。膀胱镜及膀胱造影亦证实了肠道膀胱瘘。经直肠注药造影,但未能看到具体瘘口位置。再行纤维结肠镜检,所见与第一次一样。盆腔B超和CT虽然排除了肿物,明确了瘘在乙状结肠,但难以明确病因。病人否认反复腹痛、腹泻及脓血便史。开腹探查:大小肠未见肿物及炎症表现。只是乙状结肠在膀胱后侧粘连,其前方有一段小肠粘连折返成死角,死角近侧小肠中度扩张。即予分离和修补肠壁破损。尔后分离膀胱和结肠,打开膀胱,从膀胱内探明瘘管(口径2mm以内)。见二者瘘口周围壁均正常遂予以修补,从膀胱和直肠分别注射美蓝液反复检查无渗漏后,做横结肠双腔造瘘,膀胱留置尿管。术后经过顺利,两周后行造影检查:分别由膀胱和直肠注射造影剂均未见漏出,但从横结肠造口向右侧注入钡剂发现盲?
Patient, female, 79 years old. One year before admission because of constipation in a hospital fiber colonoscopy, only 18cm is blocked, except at 15cm found a rest room no other abnormalities. 1 month after the use of barium enema to check the whole colon, failed to detect lesions and severe abdominal pain during the examination, and found a few days after the examination of small pieces, the local hospital diagnosed as “inguinal hernia” parallel “hernia repair Surgery ”. Shortly after the discovery of urine yellow and odor, but also failed to find multiple lesions after multiple examinations. Half a month before admission due to urinary excrement, abdominal pain, can not eat and transferred to our hospital. Abdominal plain film showed intestinal obstruction. Gynecology ruled out vaginal fistula and identified as bladder fistula. Cystoscopy and cystography also confirmed the intestinal fistula. Rectal injection drug imaging, but failed to see the specific location of the fistula. Repeat colonoscopy, the same as seen for the first time. Although pelvic ultrasound B and CT ruled out the tumor, clear fistula in the sigmoid colon, but difficult to clear the cause. The patient denied repeated abdominal pain, diarrhea and history of pus and blood. Open exploration: large intestine no tumor and inflammatory manifestations. Only sigmoid adhesions in the back of the bladder, in front of a small intestine folds back into a dead angle, moderate expansion of the proximal small dead angle. That is to be separated and repair intestinal wall damage. After separation of the bladder and colon, open the bladder, from the bladder to identify fistula (caliber 2mm or less). See both the fistula around the wall were normal to be repaired, respectively, from the bladder and rectum injection of methylene blue liquid repeatedly check after no leakage, do transverse colon double cavity fistula, bladder indwelling catheter. After the operation was successful, two weeks after the line angiography: respectively by the bladder and rectum injection of contrast agent were no leakage, but from the transverse colonostomy to the right barium found blind?