- 期刊
Successful Management of Perforated Duodenal Diverticulitis with Intra-Abdominal Drainage and Feeding Jejunostomy: A Case Report and Literature Review
十二指腸憩室炎合併憩室穿孔以腹腔內引流及空腸造廔手術治療成功之經驗：病例報告及文獻回顧
摘要
我們報告了以腹腔內引流及空腸造廔手術成功治療一位患有十二指腸憩室炎合併憩室穿孔病人之臨床經驗。一位53歲男性病患因腹痛及腹脹至本院求診，理學檢查顯示有上腹和右下腹壓痛但缺乏明顯之腹膜炎徵象，腹部電腦斷層攝影顯示高度懷疑十二指腸憩室炎合併憩室穿孔之影像特徵。我們先嘗試給予保守治療，但隨後因為其病況之惡化而安排了手術。術中証實了十二指腸憩室炎合併憩室穿孔的情形，我們針對後腹腔膿瘍施行了引流手術，隨後也做了空腸造廔手術以確保術後儘早進行腸道灌食，病患術後恢復良好並順利出院。由以上的經驗，我們建議在這些病人接受手術治療時一特別是在保守治療失敗後，相較於過去多數文獻所推薦的十二指腸憩室切除合併十二指腸修補手術，採行較為保守的術式，亦是另外一個可供考慮的選擇。
並列摘要
We report the clinical experience of one patient with perforated duodenal diverticulitis who was successfully treated by intra-abdominal drainage and feeding jejunostomy. A 53-year-old male patient visited our hospital due to acute onset of abdominal pain and distension. Physical examination revealed tenderness over the epigastric area and right-lower quadrant of the abdomen without obvious rebound tenderness or muscle guarding. Duodenal diverticulitis with a retroperitoneal abscess was identified by abdominal computed tomography scan. Surgical intervention was performed after the failure of conservative treatment. The operative findings were compatible with perforated duodenal diverticulitis, and intra-abdominal drainage of retroperitoneal abscess with simultaneous feeding jejunostomy was undertaken. The patient was doing well at the 4-month postoperative follow-up visit. We suggest the use of a conservative operative method, as opposed to conventional diverticulectomy and duodenorrhaphy, as an alternative approach for the management of this disorder, especially when conservative treatment has failed.
延伸閱讀
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