Masked Gastrointestinal Symptoms of Acute Cholecystitis in a Patient with High Level Spinal Cord Injury

高位脊髓損傷病患合併非典型急性膽囊炎發作

陳怡媜(Yi-Jen Chen) ； 翁銘正(Ming-Cheng Weng) ； 黃茂雄(Mao-Hsiung Huang) ； 陳天文(Tien-Wen Chen)

《安泰醫護雜誌》 19卷4期 (2013/12) Pp. 31-38

摘要

脊髓損傷常合併有內臟痛覺受損，而急性膽囊炎右上腹疼痛症狀表現不典型，容易被忽略。本病例為一位74歲男性病患因車禍導致頸部高位脊髓損傷。病患有C型肝炎，入院肝功能異常併腹脹感，腹部超音波僅發現膽囊內膽汁鬱積，先以C型肝炎急性發作治療。後因反覆高燒及腹部微脹，腹部電腦斷層發現脊椎旁及股骨大轉子周圍膿瘍，疑骨髓炎所引起，接受抗生素治療後臨床症狀並無顯著改善；爾後又反覆高燒，此時合併腹部悶痛及肌肉僵硬等症狀，追蹤電腦斷層發現膽囊壁增厚、周圍嚴重發炎，緊急放置經皮穿肝膽囊引流管，並繼續抗生素治療，臨床症狀逐漸緩解。脊髓損傷病患容易有腹脹感，但急性腹症症狀往往不明顯而容易延誤診斷。臨床上若遇到腹脹併黃疸表現的病人，腹部超音波發現膽結石或膽沙鬱積，可能是急性膽囊炎早期表現，應儘早考慮放置引流管或手術治療。

關鍵字

脊髓損傷 ； 高齡 ； 急性膽囊炎

並列摘要

Spinal cord injury can lead patients to chronic neurological complications. In patients with such injuries, the cardinal symptoms of acute abdomen would possibly be masked due to impaired visceral nociception, especially in elderly populations. We present a 74-year-old male patient with high-level spinal cord injury (C5 level, ASIA C) who suffered from constipation, abdominal distension, and jaundice without abdominal pain. Abdominal sonography revealed bile sludge without gallbladder wall thickening or biliary tract obstruction. Acute hepatitis C flare-up was favored initially. However, due to intermittent fever and persisted abdominal distension, abdominal computed tomography exam was done and revealed suspected osteomyelitis with paraspinal and greater trochanteric abscesses formation. Under the impression of suspected osteomyelitis with paraspinal and greater trochanteric abscess formation, intravenous antibiotics were prescribed, but the clinical symptoms still showed no significant improvement. Later, intermittent spiking fever and progressive abdominal distension with right upper quadrant abdominal pain and muscle guarding developed, and acute cholecystitis was impressed. He received percutaneous transhepatic gallbladder drainage and antibiotic treatment with improved clinical course. In patients with spinal cord injury, acute cholecystitis more often presents as atypical symptoms that may interfere with early diagnosis and optimal treatment. The possibility of acute cholecystitis should be kept in mind, even in patients with an already identified infection source.

並列關鍵字

spinal cord injury ； geriatrics ； acute cholecystitis