Objective To explore the experience of diagnosis and treatment of intraluminal mechanical small bowel obstruction.Methods Retrospective and descriptive research methods were used.The clinical data of 13 cases of mechanical intestinal obstruction in the general sur-gery department of Beijing Friendship Hospital,Capital Medical University from October 2016 to May 2022 were collected.All patients had differ-ent degrees of intestinal obstruction symptoms such as"pain,vomiting,distension and stop of exhaust and defecation"before operation.All pa-tients underwent emergency abdominal CT scan before operation,and the diagnosis was verified by operation.Results The 13 cases were divided into four causes:cholelithiasis in 3 cases,non-food borne foreign body in 1 case,food borne fecal stone in 8 cases and blood clot in 1 case.In the cholelithiasis group,3 cases had a history of gallstone and typical symptoms of intestinal obstruction,and the abdominal CT scan showed Rigler's triad;in the emergency operation,the normal small intestine about 10 cm from the distal end of the obstruction was longitudinally cut through the mesenteric margin,and the gallstone was squeezed out to the distal end,and the proximal intestinal decompression was performed.One case of non-food borne foreign body obstruction had a history of swallowing capsule endoscopy,and presented with symptoms of intestinal obstruction before operation;the abdominal CT scan showed that high density shadow(metal)could be seen in the small intestine,and the proximal intestinal tube was obviously dilated and effused;during the operation,the normal ileum about 10 cm away from the distal obstruction was longitudinally cut to the mesenteric margin,and the hard material was squeezed out to the distal end,and the proximal intestinal tube was decompressed.There were 8 ca-ses of food borne fecal stone obstruction.They had a history of eating"fresh persimmon,hawthorn or plum"on an empty stomach for many times,and had symptoms of intestinal obstruction before operation.The abdominal CT scan showed that the intestinal lesions completely filled the intesti-nal cavity of the obstruction segment,resulting in obvious expansion of the intestinal cavity.The density of lesions was"honeycomb"or"sieve hole"with bubbles,and the boundary was clear with wall inclusion sign.The normal small intestine about 10 cm from the distal end of the obstruc-tion was longitudinally cut through the mesenteric margin,and the fecal calculus was squeezed out to the distal end,then the proximal intestinal decompression was performed.There was 1 case of blood clot obstruction.The patient had a history of eating"fresh Hawthorn"and had symptoms of intestinal obstruction before operation.The abdominal CT scan showed multiple signs of small intestinal residue in the intestine,so it was misdi-agnosed as"fecal stone obstruction"with severe infection(abnormal increase of white blood cells)and underwent operation.No definite mechani-cal intestinal obstruction was found during operation.Postoperative gastroscopy showed gastric cardia laceration and active bleeding,and titanium clip was used to stop bleeding.Conclusion The etiology of intraluminal mechanical small bowel obstruction is complex,which may lead to misdi-agnosis.In clinical practice,we should pay more attention to the diagnostic value of medical history,physical examination,especially abdominal CT scans have important diagnostic value.Fully understanding and timely determining the cause of small intestine obstruction is the key to formula-ting a reasonable treatment plan in a timely manner.
关键词
小肠梗阻/肠腔内型小肠梗阻/机械性小肠梗阻/CT扫描
Key words
Small bowel obstruction/Intraluminal small bowel obstruction/Mechanical small bowel obstruction/CT scan
维普
万方数据