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來源資料
相關文獻
- Scrub Typhus with Presentation of Acute Abdomen
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頁籤選單縮合
題 名 | Scrub Typhus with Presentation of Acute Abdomen=以急性腹痛為表徵的恙蟲病 |
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作 者 | 陳華宗; 蕭孟芳; 李明哲; 王立信; | 書刊名 | 慈濟醫學 |
卷 期 | 14:1 2002.02[民91.02] |
頁 次 | 頁43-48 |
分類號 | 415.26 |
關鍵詞 | 恙蟲病; 東方恙蟲; 急性腹症; 腹腔鏡; Scrub typhus; Orientia tsutsugamushi; Acute abdomen; Laparoscopy; |
語 文 | 英文(English) |
中文摘要 | 恙蟲病是一種臨床表徵不太明顯的系統疾病。我們曾遭遇到兩位以不 尋常急性腹痛為表徵的恙蟲病。其一疑似非膽石性急性膽囊炎,另一例則疑似不 確定腹膜炎。兩例病蟲都有高燒、頭痛、急性腹痛,但無一有皮膚結痂的表徵。 第一例患者表現出敗血症及陽性的Murphy's徵候。就是因為有此明顯右上腹痛徵 候,加上腹部超音波呈現膽囊腫脹、膽囊壁增厚,經剖腹探查結果確定誤判為非 膽石性急性膽囊炎。第二例病患呈現敗血症及瀰漫性急性腹痛。由於無法確定是 否有腹膜炎,加上第一例的誤判經驗,我們利用腹腔鏡檢排除了真正外科腹症。 這兩例病患接受minocycline治療後,其臨床症狀很快獲得緩解,後續間接免疫 螢光血清抗體檢查抗Orientia tsutsugamushi抗體IgM在急性期皆有增高,且IgG 在舒緩期的數值是急性期的四倍以上,由此更確定是恙蟲病所致。我們建議應將 恙蟲病列入急性腹痛的鑑別診斷,尤其是在恙蟲病流行病區。我們更建議使用診 斷性腹腔鏡來檢查模擬兩可的急性腹症患者,以減少不需要的手術。(慈濟醫學 2002; 14:43-48) |
英文摘要 | Scrub typhus is a systemic illness with protean clinical manifestations. We encountered two cases of scrub typhus with unusual presentations of acute abdomen. One mimicked acute acalculous cholecystitis while the other simulated uncertain peritonitis. Both patients manifested a high fever, headache, and acute abdominal pain, but neither had eschar on their skin. The first patient presented with sepsis and a positive Murphy's sign, which was misdiagnosed as acute acalculous cholecystitis via abdominal ultrasound. An unnecessary laparotomy was performed as a result. The second patient presented with sepsis and diffuse acute abdominal pain. As the diagnosis of peritonitis was equivocal, a diagnostic laparoscopy was performed to rule out a true surgical abdomen. The clinical manifestations in both cases quickly improved after the administration of minocycline while the definite diagnosis of scrub typhus was later confirmed by a high titer of specific IgM in the acute stage and/or a four-fold increase of IgG against Orientia tsutsugamushi in the serum of convalescent patients as demonstrated by an indirect immunofluorescent antibody test. It is suggested that scrub typhus should be considered in the differential diagnosis of acute abdomen, especially in endemic areas. A diagnostic laparoscopy is highly recommended in any equivocal acute abdomen. (Tzu Chi Med J 2002; 14:43-48) |
本系統中英文摘要資訊取自各篇刊載內容。