2020年 · 第35卷第08期

The patient was a 79-year-old female. He was admitted to hospital on May 27, 2014 for the main reason of "chest tightness and chest pain for 40 years, dizziness with syncope for 20 years, cough and asthma for 2 years". Physical examination: positive upright tilt test. Chest CT examination showed chronic bronchitis, emphysema and multiple bullae in both lungs. Esophageal manometry showed lower than normal lower esophageal sphincter pressure and hiatal hernia. 24 h esophageal pH + impedance monitoring showed more weak acid reflux and non-acid reflux than normal, with a DeMeester score of 9.2. Gastroesophageal reflux disease, hiatal hernia, chronic bronchitis, vasovagal syncope were diagnosed. Laparoscopic fundoplication was performed. After 1 year follow-up, the patient's symptoms were completely relieved. Negative upright tilt test. Esophageal manometry showed normal lower esophageal sphincter pressure. No pathological reflux was observed by 24-h esophageal pH + impedance monitoring, and the DeMeester score was 1.8.

A 75-year-old male was admitted to the hospital mainly for "intermittent lower abdominal pain for 6 months, aggravated with bloody stool for 2 days". The patient had undergone laparoscopic appendectomy in an external hospital 3 years ago due to "acute appendicitis". Physical examination: body temperature 39.1 ℃, heart rate 90 beats/min, blood pressure: 184/88 mmHg. Abdominal swelling, tenderness in the whole abdomen, obvious lower abdomen and periumbilical area, accompanied by rebound pain and muscle tension, and weak intestinal sound. Anal diagnosis: No mass palpable, finger cuffs stained with blood, dark red. Abdominal CT examination showed: dilatation, fluid accumulation and gas accumulation in part of the middle and lower abdomen, visible gas-liquid plane, a small amount of fluid density shadow in the abdominal cavity, and high density shadow in the ileocecal region (Figure 1)。 Routine blood test showed: white blood cells 17.92×10⁹/L, neutrophil percentage 93.5%, hemoglobin 94 g/L. Admission diagnosis: diffuse peritonitis, incomplete intestinal obstruction. Exploratory laparotomy was performed in the emergency department. During the operation, about 300 ml of yellow pus was found in the abdominal cavity, and the small intestine was adhered to the ileocecal region about 50 cm away. The adhesions were carefully separated. The stump of the original appendix trap in the ileocecal region was pierced into the adherent small intestine wall. There was no mucosal eversion at the damaged part of the intestinal wall, surrounding congestion and edema, and the intestinal wall was thickened. The stump of the trap was about 0.8 cm long and hard (Figure 2)。 Local small intestine resection and intestinal anastomosis were performed. Anti-infection and symptomatic treatment were given after operation, and the patient recovered smoothly. Postoperative pathological examination showed acute and chronic inflammation of part of the intestinal wall, and focal necrosis of the intestinal wall with perforation.