胆囊结肠瘘致间断血便1例  

Cholecystocolonic fistula:an unusual case of intermittent bloody stool

作　　者：周立强[1] 汪理[1] 方开锋[1] 方志[1] 郑海[1] 陈立波[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院急诊创伤外科,武汉430022

出　　处：《临床急诊杂志》2013年第5期234-235,共2页Journal of Clinical Emergency

摘　　要：患者,男,54岁。因＂间断血便1个月＂入院,1个月前无明显诱因出现解柏油样稀便伴心慌、上腹不适,恶心呕吐,于当地医院就诊,诊断为＂消化道出血＂,行对症支持治疗。病情反复,曾出现解黑便后血压下降80/50mmHg（1mmHg=0.133kPa）,头晕,出冷汗等休克表现,行紧急输液扩容等抗休克治疗。经治疗患者症状好转,急送至我院就诊。既往有左肾结石病史,余无特殊。入院体检：精神略差,眼睑轻度水肿。Summary We present a very unusual case of intermittent bloody stool in a 54-year-old man.He had an inter-mittent melaena with dismay,epigastric discomfort,nausea and vomiting for a month.During the course of the dis-ease,he got a shock resulted from bloody stool.On clinical examination,a deep tenderness was found in his right upper quadrant.His hemoglobin was 92g /L,and fecal occult blood was+++.Ultrasonography revealed gall-stones and occupying lesion in gallbladder.Computed tomography suggested that gallbladder wall thickening,t he intestinal wall edema and thickening in the hepatic flexure of the colon that was not exclude neoclassic lesion.Ex-trahepatic bile duct lumen was widened that may have stones in the lower of common bile duct.Magnetic resonance cholangiopancreatography showed stones in gallbladder and the lower of common bile duct and that gallbladder wall was uneven thicken,which may be neoplastic lesion in the gallbladder.On performing colonoscopy,there was a lesion in the hepatic flexure of the colon.Finally,during the operation,we found cholecystocolonic fistula in his he-patic flexure of the colon.

关 键 词：胆囊结肠瘘 间歇性血便 下消化道出血 

分 类 号：R657.4[医药卫生—外科学]