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患者,男性,46岁。突发性上腹痛,阵发性加剧,发热6小时来诊。患者一年前摸上腹有拳头大活动性包块,近半年发现渐增大如儿头大,未诊治。半年前患脑梗塞,遗留右侧肢体轻度瘫痪。查体:T:37.8℃,BP:14/12kPa,P:120次/分,R:20次/分,发育良好,营养中等,浅表淋巴结不肿大。心肺(-)。腹部隆起,全腹压痛肌紧张,以右下腹为著。上腹触及10.0cm ×8.0cm大包块,边光滑整齐,质硬、活动度大。移动性浊音(+)、腰大肌试验(-)。实验室检验:WBC 12.9×109/L、中性71％。右下腹穿出2ml
Patient, male, 46 years old. Sudden upper abdominal pain, paroxysmal exacerbations, fever 6 hours consultation. A year ago, the patient touched the fist with a large active mass. In the past six months, he discovered that children were getting bigger and bigger, with no diagnosis and treatment. Six months ago suffering from cerebral infarction, leaving the right limb mild paralysis. Examination: T: 37.8 ℃, BP: 14 / 12kPa, P: 120 beats / min, R: 20 beats / min, well-developed, moderate nutrition, superficial lymph nodes did not enlarge. Cardiopulmonary (-). Abdomen bulge, tender abdominal muscle tension, with the right lower abdomen. Upper abdominal reach 10.0cm × 8.0cm large mass, smooth and tidy, hard, activity. Mobility dullness (+), psoas muscle test (-). Laboratory tests: WBC 12.9 × 109 / L, neutral 71%. Right lower quadrant piercing 2ml