Meckel diverticulum complicated with giant stone ileum perforation in 1 case.docVIP

 PAGE \* MERGEFORMAT 6 Meckel diverticulum complicated with giant stone ileum perforation in 1 case Of: Wang Yi, Zhang Huiming, Yang Dai-Hua, Lu Guangsheng [Keywords:] ileum colon diverticulosis A medical record Were male, 37 years old. To stop the exhaust with abdominal pain, bowel movement 10 h on April 29, 2009 admission. A year ago had “acute suppurative appendicitis” line appendectomy at another hospital, postoperative recovery was good. admission examination: T 37.7 ℃, P 82 times / min, R 20 times / min, BP 110/70 mm Hg. acute pain face. slightly bulging abdomen, right lower quadrant incision can see the old scar, healing well. the right lower abdomen and Cullen tenderness, right lower quadrant with rebound tenderness and mild muscle tension. spleen not palpable abdominal mass is not reached, abdominal percussion drum sounds, shifting dullness weakly positive. bowel sounds active. obturator muscle test positive , colon inflatable test was negative, psoas sign was negative. Laboratory tests: hemoglobin 139 g / L, RBC 5.7 × 1012 / L, WBC 12.8 × 109 / L. urine was normal. upright abdominal plain film: no free gas below the diaphragm, showing a number of gas-liquid plane shadow, to consider obstruction. right lower quadrant abdominal ultrasound found that 4.0 cm × 7.8 cm tumor, showing a small amount of ascites. intended to diagnosis: acute limitations of peritonitis; adhesion ileus? gastrointestinal perforation? appendix stump inflammation? perfect preparation before admission, on the afternoon of April 29 epidural anesthesia laparotomy. intraoperative intraperitoneal purulent fluid found in about 400 ml, peritoneal thickening congestion, detect liver, spleen and stomach were normal, the appendix had been removed stump embedding good, the surrounding tissue without edema, adhesion. ileum from the ileocecal lower segment of about 40 cm at the edge of the mesentery and ileum with a thickness that is equal, long- about 8 cm of the diverticulum, film