脊髓損傷後合併廻腸末端穿孔：病例報告

Spinal Cord Injury with Perforated Ileum: Case Report

林慶揚(Ching-Yang Lin) ； 鄭明德(Min-Teh Cheng)

《中華民國復健醫學會雜誌》 16期 (1988/12) Pp. 99-102

摘要

脊髓損傷後合併迴腸末端穿孔，為一罕見的疾病，本文報告一名37歲頸部脊髓損傷導致四肢麻痺宅女性病患，發病兩年後，突然發生腹部急症，因沒有痛覺，且其病況與理學症候不一致，經緊急作腹部超音波及電腦斷層掃瞄，發現腹腔內有積水，立即作腹部穿刺，發現有出血性腹水，即刻施行試探性剖腹手術，發現迴腸末端大穿孔，因此作迴腸部份切除及腸管吻合手術，而挽回病人生命。

並列摘要

The patient with a spinal cord lesion may not have the early signs of peritonitis such as pain, local tenderness and local muscular rigidity, therefore it is extremely difficult to make an early diagnosis of an acute abdominal lesion. Important clues to the underlying lesion may be found in referred pain, local or systemic spasticity, blood pressure and temperature variation, sweating patterns, changing abdominal sign.
This was a 37 years old female who had hospitalized following a car accident which resulted in c7 complete quadriplegiac7
Two years later, she was admitted because of severe nausea, vomitting, profused sweating, poor appetite, general weakness, and increased spasticity of abdomen, and both lower extremities. Physical examination revealed mild rigid abdomen with decreased bowel sound. There was severe pain over both shoulders. Her blood pressure, heart rate and respiratory rate showed normal. Neurologic examination remained c7 quadriplegic. The complete blood count showed evidence of hemocon-centration. Urinalysis and chest roentgenogram were normal. Strong reaction of occult blood in stool was found. Emergency examination of abdominal computed tomography and sonography were performed and ascites were found. Abdominal tapping was performed under sonography quidance, about 5cc bloody ascites were aspirated. Emergency exploratory laparotomy was performed by surgeon. About 700cc brown yeellowish bloody ascites and necrotic tissue were removed. A perforated hole about 2.5 ─3.0 cm in diameter at the proximal part of the ileocecal valve was found. The ileum was resected about 50 cm in length including the perforated hole. The specimen was sent for pathologic examination, but there revealed no evidence of preexsisting ulcer nor malignancy. In reviewing the literature concerning the gastrointestinal emergency in spinal cord injured patients, this is the first case reported with perforation from the ileum.

並列關鍵字

spinal cord injury with perforated ileum