一位39歲女性以上腹絞痛、嘔吐及右下腹痛為表現

A 39-Year-Old Woman Presented with Abdominal Pain (colic), Vomiting and Right Lower Quadrant Abdominal Pain

急性腹痛為急診常見主訴之一，其中成人腸套疊診斷著實罕見，以腹部絞痛、噁心嘔吐及腹脹為臨床表現，若未及時處置，病患可能因為腸段套疊造成腸阻塞，導致腸壁缺血、壞死或穿孔，甚至惡化為腹膜炎或敗血症。本文個案為一位39歲女性，因上腹絞痛、嘔吐及右下腹痛至急診求治，藉由病史收集、身體評估、實驗室檢驗無法確立診斷，於腹部電腦斷層檢查後確診為迴腸結腸腸套疊，因此緊急安排腸套疊復位手術，術中發現被套入包覆的闌尾已腫脹發炎，一併執行闌尾切除手術；個案經手術介入後給予充足輸液、傷口照護與多策略方式止痛，恢復漸進式飲食與活動後順利出院。成人腸套疊罕見且缺乏特異性症狀，導因多元且常與腫瘤相關，其次為感染等特發性因素，藉由身體評估困難診斷，因此建議臨床照護人員，當成人病患出現腹部絞痛、噁心嘔吐及腹脹表現時，應考慮納入腸套疊，盡速安排腹部電腦斷層診斷，評估是否需要介入手術治療，以提供病患適切即時的醫療照護。

 

Acute abdominal pain is one of the most common complaints of patients admitted to emergency unit but the diagnosis of intussusception in adults is really rare. The clinical symptoms include abdominal pain (colic), nausea, vomiting and distension. Obstruction, ischemia, necrosis, or perforation of the bowel could be induced by intussusception, and even deteriorating into peritonitis or sepsis if not be-ing treated properly. The case in this study is a 39-years-old woman presented with acute abdominal pain (colic), vomiting and right lower quadrant abdominal pain. The diagnosis could not be established by medical history taking, physical examination and laboratory survey. Ileocolic intussusception was diagnosed by abdominal computed tomography, and reduction of intussusception was arranged ur-gently. Swollen appendix with inflammation was also noted during the operation, thus appendectomy was performed. The patient was discharged after progressive diet and treatments such as providing ad-equate fluid infusion, wound and pain management. Adult intussusception is rare and lack of specific symptoms. The causes of intussusception are various and often related to tumors or sometimes idio-pathic factors such as infection. It is difficult to diagnose intussusception through physical examina-tion. Therefore, intussusception should be considered when adult experience abdominal colic, nausea, vomiting and distension. Abdominal computed tomography should be arranged as soon as possible, and surgical intervention should be provided appropriately for immediate medical care for patients.