- 期刊
Volvulus of Gallbladder: Report of a Case
膽囊扭轉：病例報告
摘要
一位七十六歲女性患者，因持續腹痛，噁心且嘔吐達4日而到院治療。腹部超音波和腹部和骨盆的電腦斷層掃瞄結果顯示擴張的小腸，升結腸與萎縮的降結腸。基於臨床的症狀和影像檢查，術前所做的可能診斷為腸阻塞。剖腹手術後的正確診斷是膽囊扭轉並有壞疽性的變化。在扭曲的膽囊莖部拉直後，順利的執行膽囊切除術。病患術後恢復良好並在手術後十天出院。這個案例強調術前診斷膽囊扭轉的困難，即使目前可使用先進的診斷性放射線影像技術，大部分案例的正確診斷仍於手術中才能確立。假如正確判斷和迅速的處置，膽囊扭轉仍有良好的預後，但一旦在診斷和治療有所延誤，可導致嚴重的併發症。
關鍵字
無資料並列摘要
This report describes a 76-year-old female who presented with progressive abdominal pain, nausea and vomiting for 4 days. Abdominal ultrasound and computed tomography of the abdomen and pelvis showed a distended small bowel, ascending colon with collapse of the descending colon. Bowel obstruction was the tentative preoperative diagnosis based on clinical symptoms and imaging studies. Gallbladder volvulus with a gangrenous change was the definite diagnosis following a celiotomy. Cholecystectomy was performed smoothly. The postoperative course was uneventful and the patient was discharged 10 days after surgery. This case highlights the difficulty of preoperative diagnosis for gallbladder volvulus; accurate diagnoses in most cases are made intraoperatively in spite of currently available imaging studies. Prompt management with open or laparoscopic cholecystectomy decreases the mortality rate due to fatal complications resulting from gallbladder rupture.
延伸閱讀
- Fang, Y. J., Yang, C. C., Yeh, Y. H., Liu, Y. T., Lin, C. L., Wu, C. S., Chen, C. H., & Kuo, C. L. (2002). 膽囊動脈僞動脈瘤合併膽道出血：一病例報告. 臺灣消化醫學雜誌, 19(2), 161-168. https://doi.org/10.6557/GJT.200206_19(2).0007
- Liu, C. L., Yang, K. C., & Lin, Y. N. (1987). 膽囊囊腺瘤：一例報告. 中華民國消化系醫學會雜誌, 4(2), 68-71. https://doi.org/10.6557/GJTa.198706_4(2).0004
- Tzeng, J. E., Shyu, D. W., & Chu, Y. T. (2003). 膽囊類癌－病例報告. 慈濟醫學雜誌, 15(6), 413-416. https://doi.org/10.6440/TZUCMJ.200312.0413
- Chen, C. J., Wang, T. E., Lin, S. C., Liu, C. L., & Shih, S. C. (2002). 膽囊扭轉：五例報告及文獻回顧. 中華民國急救加護醫學會雜誌, 13(4), 171-177. https://doi.org/10.30018/JECCM.200212.0004
- 陳青富、王蒼恩、林錫泉、張文熊、施壽全（2008）。急性氣腫性膽囊炎：一病例報告。內科學誌，19(4)，360-364。https://doi.org/10.6314/JIMT.2008.19(4).11