以局部注射治療腹壁疼痛：病例報告

Treatment of Abdominal Wall Pain by Local Injection: A Case Report

當一位病患主訴下腹痛，無合併發燒、噁心、嘔吐、頻尿、腹瀉、腹部僵直或反彈痛等急性症狀，且一般血液、尿液及生化檢驗、超音波和X光等檢查皆正常，只是病患曾有下腹手術的病史時，便需要考慮引起腹痛的病灶不在臟器而可能是腹壁神經受損。本文報告──懷孕13週、曾接受盲腸切除手術的婦女，因右下腹痛持續7天未見改善而求診，理學檢查除右下腹有痛點(trigger point)外，其它一切正常，實驗室檢查均屬正常範圍。婦產科檢查方面，除子宮內懷孕13週外，亦無特別異常。患者經腹壁肌肉局部注射藥物後，得到立竿見影的止痛效果，減少病患的疼痛。

When a patient suffers from lower abdominal pain without obvious disease, practitioners should consider that the pain does not originate from the abdominal visceral organs. In fact, the pain may originate from extra-abdominal structures (i.e., abdominal wall) if the pain is located in a single dermatomic area. We present herein a 28 year-old female with a 13-week pregnancy complaining of right lower abdominal pain of 7 days duration. The laboratory data, including complete blood count, liver function tests, renal function tests, electrolytes, amylase and C-reactive protein, were all within normal limits. The physical examination revealed a trigger point over the right lower abdomen. A local injection consisting of bupivacaine, lidocaine, and betamethasone was given in the right lower quadrant abdomen and the pain dramatically subsided. The diagnosis of abdominal wall pain is an important component in avoiding unnecessary operations and delayed treatment in patients with abdominal pain.