Transconjunctival-Intraorbital Injury by a Chopstick: A Case Report

竹筷引起之經結膜－眼窩內眼球外傷：病例報告

莊智鈞(Chih-Chun Chuang) ； 郭芝岑(Jane Zea-Chin Kuo) ； 黃奕修(Yih-Shiou Hwang) ； 馬惠康(David Hui-Kang Ma) ； 林耕國(Ken-Kuo Lin) ； 陳宏吉(Hung-Chi Jesse Chen)

《中華民國眼科醫學會雜誌》 48卷3期 (2009/12) Pp. 325-329

https://doi.org/10.30048/ACTASOS.200912.0014

摘要

目的：報告竹筷引起之經結膜－眼窩內眼球外傷之病例。
方法：病例報告。
結果：29歲外勞男性因喝酒打架撞擊左眼，於外院住院治療三天並未發現眼窩內有異物。但因左眼持續紅腫，轉至本院就醫。進一步的檢查顯示除了左眼結膜紅、水腫，病患並未有其它症狀。電腦斷層檢查發現內側有不明顯的物體，於是緊急安排探查手術。術中發現五公分竹筷卡在結膜下至眼窩。傷口細菌培養報告顯示Klebsiella pneumoniae, Enterococcus faecium, Citrobacter freundii, Viridans streptococcus，與Enterobacter cloacae感染。
結論：因竹筷、木製品不容易於電腦斷層顯現明顯異常，同時比較會使細菌聚集造成腦膜炎並導致較高的死亡率，此病例提示醫師當遇到不詳細的病史並懷疑外來物體時，建議安排影像檢查並於需要時施行緊急探查手術及抗生素使用，以避免嚴重的併發症。

並列摘要

Purpose: To report a case of transconjunctival-intraorbital injury by a chopstick
Method: Interventional case report
Result: A 29 year-old male was treated previously at another hospital with delayed diagnosis of a retained wooden foreign body. Orbital CT showed a moderately enhanced object nasally and a 5cm long chopstick fragment was found during surgery. Wound culture revealed mixed infection of Klebsiella pneumoniae, Enterococcus faecium, Citrobacter freundii, Viridans streptococcus, and Enterobacter cloacae. The post-operative course was uneventful with antibiotics treatment.
Conclusion: Wooden foreign bodies are moderately enhanced on CT. Since delayed diagnosis of retained intraocular wooden foreign bodies possesses the possibility of intracranial invasion and results in high mortality rate, surgical exploration and antibiotics are considered when retained wooden foreign bodies are suspected to radiology.

並列關鍵字

Wooden foreign body ； chopstick ； transconjunctival-intraorbital injury ； meningitis