- 期刊
Acute Abdominal Pain in Spinal Cord Injury Patient Induced by Indwelling Urethral Catheter Placed into the Right Ureter through the Ureteral Orifice: A Case Report
脊髓損傷病患因放置尿管所引起罕見併發症：病例報告
摘要
尿管的放置在現今的醫療中被廣泛的使用。一般而言，被認爲是相當安全有效的方式，我們要報告一個因放置尿管而引發的罕見併發症。一位45歲的女性在兩年因外傷導致胸髓第十節以下的完全性脊髓損傷。病患因下腹痛、發燒及畏寒，前往就診，給予口服抗生素及換置尿管。但之後，下腹疼痛加劇，因此住院接受進一步檢查及治療。理學檢查發現病人廣泛性腹部壓痛及肌肉緊張，實驗室數據除了白血球增多外，肝腎功能皆變差。尿液檢查有膿尿及血尿。腹部電腦斷層掃描發現右側水腎及輸尿管腫脹，另外尿管頂端被置於右側輸尿管底部。因此，給予換置尿管並繼續使用抗生素。在換置尿管之後，病人臨床症狀大幅改善。三天後的實驗室數據回復正常。在患置導尿管之後第四天，安排膀胱鏡檢，除膀胱呈現慢性發炎病變外，兩側輸尿管開口結構正常，並未發現明顯之異常。病人在完成抗生素治療之後順利出院。因放置導尿管而導致輸尿管外傷的機率甚少，目前只有零星的病例報告。而這些案例大都發生在女性且膀胱已排空時，故應該要特別注意。我們建議在臨床上，對於脊髓損傷病人腹部疼痛早期使用超音波、腹部電腦斷層甚至剖腹探查可以早期診斷脊髓損傷病人的腹部急症，進而改善其預後及死亡率。
並列摘要
Diagnosis of acute abdomen in spinal cord injury (SCI) patients remains challenging. Classic peritoneal signs, such as rigid abdomen, rebounding pain and abdominal muscle guarding may be not reliable. It is still an important cause of morbidity and mortality in patients with SCI. A 45-year-old woman with SCI and 7th and 8th thoracic vertebrae fractures suffered from lower abdominal pain, fever and chills for three days. Physical examination revealed diffuse abdominal tenderness with muscle guarding. Laboratory studies showed severe leukocytosis and mild pyuria. Abdominal contrast-enhanced computed tomography scans (CTS) revealed a urinary catheter, which had been accidentally inserted into the right ureter through the ureteral orifice. Abdominal pain improved dramatically after the urinary catheter was replaced. We suggest further workup for possible causes of acute abdominal pain in SCI patients presenting with symptoms such as vomiting, vague abdominal pain, abdominal distension, spasms and cramps. Early investigation with abdominal X-ray, ultrasound, computed tomography scan or diagnostic video laparotomy may prevent delays in diagnosis and improvement of outcome.
延伸閱讀
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