A 73-Year-Old Man with Long-Term Immobility Presenting with Abdominal Pain 英文参考文献.docVIP

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A 73-Year-Old Man with Long-Term Immobility Presenting with Abdominal Pain 英文参考文献.doc

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A 73-Year-Old Man with Long-Term Immobility Presenting with Abdominal Pain 英文参考文献

LearningForum A73-Year-OldManwithLong-TermImmobility PresentingwithAbdominalPain SalomoneDiSaverio1*,GregorioTugnoli1,PaoloEmilioOrlandi2,MarcoCasali1,FaustoCatena3 ,Andrea Biscardi1,OmeshniePillay4,FrancoBaldoni1 1DepartmentsofEmergencyandSurgery,EmergencySurgeryandTraumaSurgeryUnit,TraumaCenter,MaggioreHospital–BolognaLocalHealthDistrict,Bologna,Italy, 2Department of Radiology, Maggiore Hospital–Bologna Local Health District, Bologna, Italy, 3Department of Emergency and Transplant Surgery, S. Orsola Malpighi UniversityHospital,Bologna,Italy,4AddingtonHospital,Durban,KwaZulu-Natal,SouthAfrica In summer 2008, a 73-year-old man Box1.IntestinalObstruction:DiagnosticWorkup arrivedintheemergencyroomwithvague abdominal pain. On examination, his abdomen was distended and tympanic, butsoftandnon-tenderonpalpation.The patient had been immobile and bed- ridden since 1995, when he had neuro- surgical resection of a medullary ependy- momaofthespine,withresidualparaple- N N SupineanderectplainabdominalX-ray Abdominal ultrasound (this is of limited value in bowel obstruction and/or in patients with distended bowel because the air, limiting ultrasound transmis- sion,mayobscureandcamouflagetheunderlyingfindings) N N CTscan Conventional barium follow-through examination, upper gastrointestinal and smallbowelseries,enteroclysis(fluoroscopicX-rayofthesmallintestine)[18] gia, neuropathic peripheral neuropathy, with and a secondary N bladder Water-solublecontrastfollow-through(thisinvestigationissaferthanbariumin casesofperforationandperitonealspreadandhaspossibletherapeuticvaluein thecaseofadhesivesmallintestineobstruction[19]) chronic renal failure. The patient had a medical history of hypertension and type II diabetes mellitus and suffered from chronic constipation with recurrent epi- sodesofpartialbowelobstruction. N N N N N Contrast(bariumorwater-soluble)enema CTscanwithdoublecontrast(intravenousandoralorrectal) Magneticresonanceimaging Given his past history, the current p