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題 名 | 大腸鏡術後之脾臟破裂--一病例報告及文獻整理=Splenic Rupture after Colonoscopy--One Case Report and Literature Review |
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作 者 | 劉家源; 江瑞安; 王柏川; 白明忠; 彭國權; | 書刊名 | 內科學誌 |
卷 期 | 12:2 2001.04[民90.04] |
頁 次 | 頁88-93 |
分類號 | 416.249 |
關鍵詞 | 脾臟破裂; 大腸鏡術; 併發症; Splenic rupture; Colonoscopy; Complication; |
語 文 | 中文(Chinese) |
中文摘要 | 大腸鏡術最常見之併發症為大腸出血及穿孔,其他併發症雖然罕見,仍需謹記在 心方能及時診斷。脾臟破裂是一罕見,且具潛在致命危險之大腸鏡術併發症。我們報告一位 67 歲男性病患, 於過程順利之大腸鏡術後發生脾臟破裂,並與英文文獻之 18 個病例進行 回顧比較。大腸鏡術後發生脾臟破裂可能機轉有:一、大腸鏡對脾臟造成直接鈍性傷害;二 、過度拉扯脾結場韌帶引起脾外膜撕裂或破裂;三、脾臟與結腸間可移動程度相對減少 (如 沾黏 ),使脾外膜撕裂或破裂機會增加。腹痛與貧血是兩個最常見症狀,放射到左肩部疼痛 (Kehr's sign) 則較具特異性。電腦斷層由於不受腸氣干擾,且可協助排除其他併發症與評 估傷害程度,是最常用之診斷工具。脾臟切除術是大多數病例之治療方式。然而,在生命徵 象穩定時,內科保守治療則是另一種選擇。我們認為,當大腸鏡術後出現腹痛或貧血時,若 能排除腸道出血及穿孔,則脾臟破裂必須列入鑑別診斷,才能及時診斷並加以治療。 |
英文摘要 | Complications of colonoscopy are infrequent and consist mainly of colon perforation and hemorrhage. Other complications, rarely considered because they occur even less frequently, must be kept in mind to make a diagnosis in time. Splenic rupture is a very rare complication of colonoscopy and only 18 cases in English published literature are found. A high index of suspicion is the crucial factor in prompt diagnosis of this rare but potentially fatal complication. We present a case of a 67-year-old man as a victim of splenic rupture by colonoscopy and review the literature. Presumed mechanisms of splenic rupture during Colonoscopy are (1) direct blunt trauma to spleen, (2) excessive splenocolic ligament tractiion and (3)decrease in the relative mobility between the spleen and colon (ex. adhesion). Abdominal pain and anemia are the most common symptoms in this condition. The referred pain to left shoulder (Kehr's sign) is a more specific symptom. The computed tomography scan, which not affect by air from GI tract, is most valuable tool used for diagnosis. It is more helpful in evaluating the severity of damage and excluding other complications. Although most cases in literature underwent splenectomy for treatment, conservative management could be a good choice if the vital signs were stable. After excluding the possibility of interstinal perforation or hemorrhage, splenic rupture must be considered in anyone who got abdominal pain or anemia after colonoscopy. |
本系統中英文摘要資訊取自各篇刊載內容。