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| 題 名 | Hirschsprung's Disease in an Adult with a 37-year History of Colostomy=一個成人型赫司朋氏病病患伴隨人工肛門37 年:病例報告 |
|---|---|
| 作 者 | 林雨利; 張天傑; 邱錫雄; 劉添裕; 柯端英; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
| 卷 期 | 21:2 2010.06[民99.06] |
| 頁 次 | 頁111-114 |
| 分類號 | 416.245 |
| 關鍵詞 | 成人; 赫司朋氏病; 人工肛門; Hirschsprung's disease; Adult; Colostomy; |
| 語 文 | 英文(English) |
| 中文摘要 | 一個37 歲男性病患因反覆性腹部疼痛而來院求治。理學檢查發現在左側腹壁上有一個 人工肛門。根據病患自己的描述,他於出生後 (1970 年) 不久即因腸阻塞而接受人工肛 門手術。雖然於7 歲時接受人工肛門關閉手術,但隨即因腹脹併發敗血症而再次接受人 工肛門手術。經直腸切片檢查後,確認為赫司朋氏病。病患於接受改良型Duhamel 直腸 拉出手術後,症狀明顯改善。台灣外科先驅洪文宗教授於1960 年代開始施行赫司朋氏 病的直腸拉出手術,一直到1970 年代才開始廣泛施行於整個台灣。在這之前的赫司朋 氏病病患如何治療呢?雖然人工肛門可用以維持病患的生命,但並無法緩解病患腹部的 不適。我們報告這一個病例並回顧相關的文獻及台灣治療赫司朋氏病的歷史。 |
| 英文摘要 | In adults Hirschsprung’s disease is a rare and frequently misdiagnosed cause of longstanding refractory constipation. A 37-year-old man visited our emergency department because he had been experiencing dull abdominal pain for days. The patient had received a colostomy for intestinal obstruction shortly after birth. He received takedown of the colostomy when he was 7-year-old, but the colostomy was performed again due to persistent intestinal obstruction. However he continued to suffer from similar symptoms thereafter. Physical examination revealed a colostomy stoma on the left upper quadrant of his abdomen and moderate tenderness to palpation in both the right and left quadrants. Abdominal plain film revealed fecal and barium impaction. A diagnosis of Hirschsprung’s disease was made when a rectal biopsy was performed and no ganglion cells were noted. The patient underwent a modified Duhamel’s pull-through operation and a protective colostomy. No abdominal discomfort was noted before he discharged or during followed up. Adult Hirschsprung’s disease is a rare entity. Although several reports have mentioned adult Hirschsprung’s disease, there are no reports describing a case with a colostomy after birth. We report this case and discuss the history of management of Hirschsprung’s disease to help explain the reason for delayed treatment in this patient. |
本系統中英文摘要資訊取自各篇刊載內容。