义齿嵌顿致乙状结肠穿孔一例误诊分析  

A Case of Misdiagnosis of Perforation of Sigmoid Caused by Denture Impaction

作　　者：敖文静 满泉 苗卓瑞 庞慧芳 AO Wenjing;MAN Quan;MIAO Zhuorui;PANG Huifang(Clinical Medical College of Tongliao Affiliated to Inner Mongolia Medical University,Tongliao,Inner Mongolia Autonomous Region 028000,China;Department of Emergency,Tongliao People's Hospital,Tongliao,Inner Mongolia Autonomous Region 028000,China;Department of Hepatobiliary and Pancreatic Surgery,Tongliao People's Hospital,Tongliao,Inner Mongolia Autonomous Region 028000,China;Digestive Endoscopy Center,Tongliao People's Hospital,Tongliao,Inner Mongolia Autonomous Region 028000,China)

机构地区：[1]内蒙古医科大学通辽临床医学院,内蒙古自治区通辽市028000 [2]通辽市人民医院急诊科,内蒙古自治区通辽市028000 [3]通辽市人民医院肝胆胰外科,内蒙古自治区通辽市028000 [4]通辽市人民医院消化内镜中心,内蒙古自治区通辽市028000

出　　处：《临床误诊误治》2025年第8期18-22,共5页Clinical Misdiagnosis & Mistherapy

基　　金：内蒙古自治区自然科学基金项目(2024MS08032)。

摘　　要：目的探讨结直肠异物嵌顿误诊致乙状结肠穿孔的原因及防范措施。方法回顾分析结直肠异物嵌顿误诊致乙状结肠穿孔1例的临床资料。结果患者5个月前误吞义齿后出现腹痛、腹胀,3 d后腹部X线平片示肠道异物,1周后复查腹部X线未见异常,误认为异物已排出。后仍间断有腹痛、腹胀症状,因病情加重并伴便血再次就诊。行结肠镜、腹部X线及腹部CT检查,初步诊断不完全性肠梗阻:结肠狭窄、异物嵌顿可能,给予剖腹探查见乙状结肠明显充血水肿,其内触及硬质异物,致肠管狭窄,取出异物(义齿),嵌顿处可见气体溢出,考虑穿孔,给予修补缝合穿孔及切口部位,术后给予禁食水、胃肠减压、止血、抗感染、补液及营养支持等治疗,恢复良好,第10天出院。误诊时间5个月。术后2个月电话随访,患者无腹痛、腹胀等不适,排便恢复正常,体质量增加3 kg。结论详细询问病史及完善各项检查可以避免结直肠异物嵌顿致穿孔误漏诊及其导致的严重后果,尽早确诊、及时治疗患者预后良好。Objective To explore the causes of misdiagnosis and preventive measures of perforation of sigmoid colon caused by foreign body impaction in the colorectum.Methods The clinical data of 1 patient with perforation of sigmoid colon caused by foreign body impaction in the colorectum that had been misdiagnosed were retrospectively analyzed.Results A patient had abdominal pain and distension after swallowing a denture by mistake 5 months before.Plain abdominal X-ray was taken at 3 d afterwards,which showed intestinal foreign bodies.One week afterwards,the plain abdominal X-ray was retaken and no abnormalities were found.It was mistakenly believed that the foreign body had been expelled.There are still intermittent symptoms of abdominal pain and bloating afterwards,and the patient was treated again 3 days ago due to aggravation and hematochezia.Colonoscopy,plain abdominal X-ray and abdominal CT were performed to make a preliminary diagnosis of incomplete ileus,stenosis of the colon and possible foreign body impaction.Laparotomy revealed obvious hyperemia and edema of the sigmoid colon,which involved hard foreign bodies and caused intestinal stenosis.The foreign bodies(denture)were removed and gas could overflow from the site of impaction.Perforation was considered,repair and suture the perforation and incision site were provided,and the postoperative treatment of fasting water,gastrointestinal decompression,hemostasis,anti-infection,rehydration and nutritional support were given.The recovery was good,and he was discharged on the 10th day.The misdiagnosis lasted 5 months.At 2 months after surgery,the patient was followed up by phone and reported no discomfort such as abdominal pain or bloating.The bowel movement returned to normal and the body weight was increased by 3 kg.Conclusion Detailed medical history and improvement of various examinations can avoid misdiagnosis and missed diagnosis of perforation and serious consequences caused by foreign body impaction in the colorectum.Early diagnosis and timely treatment can en

关 键 词：义齿嵌顿 乙状结肠穿孔 结直肠异物 误诊 

分 类 号：R768[医药卫生—耳鼻咽喉科]