- 期刊
Foreign Body Related Micro-Perforation Managed by Colonoscopy after A Failed Laparoscopic Exploration-A Case Report
利用大腸鏡來處置腹腔鏡探查失敗的異物所引起之細微腸穿孔
摘要
腸穿孔在沒有其他系統性疾病的年輕人常導源於異物吞食或外傷。傳統上，手術是腸穿孔的標準治療，但是吞食異物導致的腸穿孔內視鏡異物移除有它治療上的角色。一般的手術方式是腹部中線切開的剖腹探查，因為這種手術方式可以提供較好的視野；到目前為止，提到使用腹腔鏡診斷與治療異物導致腸穿孔的文獻有限，可能與腹腔鏡的視野較小與外科醫師不能用雙手觸摸有關。我們報告一位28歲男性病人間歇性肚臍四周疼痛7天，同時患者曾於15天前誤食牙籤。雖然腹部電腦斷層顯示左上腹有腹腔積氣，但是腹腔鏡手術卻沒有發現腸穿孔的證據。在腹腔鏡手術後3天，大腸鏡發現牙籤在直腸乙狀結腸交界處並且成功取出異物。在異物導致的細微腸穿孔，內視鏡異物取出是另一種治療方式。
關鍵字
無資料並列摘要
Hollow organ perforation is usually resulted from foreign body ingestion or trauma in young patients without systemic disease. Surgery is the traditionally definite therapy for intestinal perforation, but endoscopic removal of foreign bodies is an alternative method in foreign body-related intestinal perforation. An exploratory laparotomy with midline incision is usually performed and provides access to the entire abdomen, but sporadic articles mentioned about perforating foreign body diagnosed and managed by laparoscopy due to its narrow vision and impalpability. We reported a case of a 28-year-old male without systemic disease suffered from intermittent peri-umbilical pain for 7 days. The patient swallowed a toothpick 15 days prior to examination. Although abdominal computed tomography revealed pneumoperitoneum in the left upper quadrant area, laparoscopy showed no evidence of hollow organ perforation. Colonoscopy successfully found and removed a toothpick at the rectosigmoid junction 3 days after laparoscopy. Laparotomy, but not laparoscopy, is the traditionally definitive diagnostic and therapeutic method, and endoscopic therapy could be an alternative and salvage method in foreign body-related intestinal perforation.