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患儿男,1岁4个月。5 d前因不洁饮食后出现频繁腹泻伴发热,在个体诊所就诊,诊为“急性肠炎”进行治疗,多次口服阿斯匹林和消炎痛混合粉剂降温,病情有所好转。入院前8 h,患儿出现剧烈腹痛、腹胀并迅速加重。查体: T 40．2℃,脉搏180次／min,呼吸35次／min,血压 80／55 mm Hg,表情淡漠,胸式呼吸。腹部膨隆,全腹压痛、反跳痛、肌紧张,叩诊鼓音、肝浊音界消失,移动性浊音阳性,肠鸣音减弱。血常规:白细胞18．2×109／L,中性粒细胞0．84。大便常规:稀水样便,潜血阳性。腹部X光平片提示右膈下较大液平面(图1)。B超提示有大量腹水。诊断性腹腔穿刺抽出淡黄色有渣腹水。初步诊断为腹部空腔脏器穿孔并弥慢性腹膜炎。行急诊剖腹探查,开腹即有气体喷出,腹腔内有大量混浊腹水,网膜囊内有食物残渣,吸出约500 ml。十二指肠球部后壁紧靠近胰头部有直径1cm的溃疡穿孔, 边缘组织无明显异常,无瘢痕。行毕罗Ⅱ式胃部分切除术。术后10d治愈出院。
Children male, 1 year old 4 months. 5 d before due to unclean diet frequent diarrhea with fever, treatment in individual clinics, diagnosed as “acute enteritis” for treatment, repeated oral aspirin and indomethacin mixed powder cooling, the condition has improved. 8 h before admission, children with severe abdominal pain, abdominal distension and rapid increase. Examination: T 40.2 ℃, pulse 180 beats / min, breathing 35 beats / min, blood pressure 80/55 mm Hg, apathy, chest breathing. Abdominal bulge, total abdominal tenderness, rebound tenderness, muscle tension, percussion drum sounds, liver dullness disappeared, mobility dullness positive, bowel sounds weakened. Blood: white blood cells 18.2 × 109 / L, neutrophils 0.84. Stool routine: dilute watery stools, occult blood positive. Abdominal X-ray showed a larger liquid level in the right subphrenic (Fig. 1). B-tips have a lot of ascites. Diagnostic paracentesis extracted pale yellow with ascites. Preliminary diagnosis of abdominal hollow organs perforation and diffuse chronic peritonitis. The emergency laparotomy exploration, open that there is a gas jet, a large number of intra-abdominal opacity ascites, omentum capsule with food debris, aspiration of about 500 ml. Duodenal bulb posterior wall close to the head of the pancreas 1cm in diameter ulcer perforation, no obvious edge of the organization, no scars. Line Biluo Ⅱ partial gastric resection. After 10d cured.