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Chronic Bowel Obstruction in a Middle-aged Man
JAMA Surgery ( IF 16.9 ) Pub Date : 2019-01-01 , DOI: 10.1001/jamasurg.2018.2582
Ross M. Beckman 1 , Kent A. Stevens 1 , Christian Jones 1
Affiliation  

A man in his 50s of West African descent with a history of prostate cancer treated with robotic prostatectomy 2 years ago presented with 1 year of progressively worsening postprandial nausea or vomiting, epigastric abdominal pain, anorexia, and weight loss of 27 kg. Four months earlier, he had presented to another hospital and received a diagnosis of adhesive small bowel obstruction, for which he underwent laparotomy and lysis of small adhesive bands that provided only temporary symptomatic improvement. At his current presentation, he was unable to tolerate any oral intake and entirely dependent on total parenteral nutrition. On examination, he was cachectic with a moderately distended, nontender abdomen. The result of a blood test (QuantiFERON-TB Gold; Qiagen) was positive for tuberculosis exposure. An abdominal computed tomography scan showed markedly dilated stomach and duodenum with decompressed, thickened distal small bowel without a clear transition point.



中文翻译:

一名中年男子的慢性肠梗阻

2年前,一名50多岁的西非裔人有前列腺癌的历史,并接受了机器人前列腺切除术治疗,结果出现了1年的病情逐渐恶化,餐后恶心或呕吐,上腹部腹痛,食欲不振和体重减轻了27公斤。四个月前,他曾到另一家医院就诊,并诊断出粘连性小肠梗阻,为此他进行了剖腹手术并溶解了小的粘连带,这些粘连仅提供了暂时的症状改善。在目前的介绍中,他无法忍受任何口服摄入,并且完全依赖于肠胃外的全部营养。经检查,他的腹部呈中度扩张,温和的状态,呈恶病质。验血结果(QuantiFERON-TB Gold; Qiagen)对结核病暴露呈阳性。

更新日期:2019-01-17
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