![](/m3/static/images/logo-blue.png)
胃憩室穿孔1例
大外科
![](https://pub-med-avatar.medlinker.com/15355986386pl546qz.jpg)
方医师![](data:image/png;base64,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)
![](data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABoAAAAaCAYAAAHeTXxYAAAAAXNSR0IArs4c6QAAA8VJREFUSA2tVk1IVFEU/t5zVCYKnFxICbapxk0oVNB2jARFiSikRa5clYKjgoS4GFFEBYcRyl2tWomBFbQJm02Ekrpw0w+CENIuRwgcqMnb+e5998176mgLD7x7z/+599xz7n2AgOrvv6ySyUHiUL29cUUoFJTgyoXj3MbwMFBWphWslpb6HFH9RcKhjeW6GrlyxdLau5Y6ZAVVrYozM+O41hkyGaCmBhgf13IaHGlpvUC2806+r5bhqFQqglzuj2V4c9b1mQ8fGt7AAOeEWfulS0A8Dr2QN2+0QkSP3d1AMqlROzBTT/czKXSdTKYHkcg1qymK77lRvRcyvdX9FtTn+cpExLN2YhUkE3sWp/xIkMguEyJKRe9MLT/CgwcGb2szNMdCYYUpqPM5/f3A8jKwsmKUP3wwordvfRUiEVln3D/ZOrFPp43CixdFxT2u3gMmw+Ji+F7whKUPnaPRs87ERM43skpeDXdBqfOSsSW4breTTn+zcs6+kSg/EUU5xkNBIRarcFKpAqXa6L+WRu1YrJyGrhoYuCrk0XuhASGX4+HDZd6JaKitLZ4RGRcuhGlZGXvXlKoxAdrbDXaVwQX6+swcHPf2noaN6uuBjx+Bjg5gYgL4/DmobnClboSNyJ6bAyorgfJyYHERCB4s5Y7zwzQMiYYGKXXvdnj+HFhfB+7dAzY2KA3CMzYTK8HsJ5s1QhoQGhuBr35za5aU3ZQ9Jy+E5pcevJ4ye5KaKq3pS7KhJrRsKaVF2VeTpf1ZGs+Znl61tF97lmFnXSl//04d6sQqBWfmpqxsMOg8JA4S6vHjGPL5l8L7v1IMGofxLKLRu2w9y/brQXdTPr99AkHoOyEL3tY+vUjmZEvlmUqjo8CZM8D8PGCvJs9YT83NQGsrsLsLDA0FJQbnLZTJ3IxI1MGS55CQDDII4c4dYFXONp83NLtgUN7Q6mpDfwvdO4bHUQqFMZi6riI3gPGdbWkpMkjfv29oNvXkZDEIufsaoWiosS5XIp7fxzQkg1RUADs7JiV/5HVki46NAZ2dvJPMZWCNS+3IyM+xZZesrj+fOgU0ea3x+rXJ/+ysEZ8+DSwsACMjwMWLhvfzJ8CvNCxHZEc9Iv8S0uHj5UpWt7aAtTUj2tw88Erru4PSo9NGX92m6niNFwqfxETTxvOJjEp+Cq6ziXUf6W6WV0dce9fdiQTJ6pfMu4YO7ED/eezsZCSljyTcAfkxS1By5rOoqkrap9LqH+tIntO4GN8Wg1vy1flVKi+G0N/leye8V/KfFL7oRRCEf1hNVyqc6pcYAAAAAElFTkSuQmCC)
四川大学华西医院
主诉 病史
中年男性患者,因“上腹痛、黑便 3 天”就诊,查体:生命体征平稳,面色苍白,上腹轻压痛,血常规示 Hb7.7g/dL,胸片示膈下游离气体影,腹部 CT示胃大弯侧局部扩张,可见高密度残渣(血液或食物颗粒可疑)。因患者病情平稳,无明显恶化或活动性出血倾向,予保守治疗;2 周后行胃镜随访时,发现胃大弯侧可见 4cm 囊袋,内含少量咖啡样物质及食物残渣。综上所述,考虑为胃憩室,合并出血及穿孔。患者行经腹腔镜下憩室切除术,病理回示胃粘膜层疝,无肌肉层覆盖,即胃假憩室。M. F. Ho, A. Y. Teoh,Perforated gastric diverticulum with bleeding.Endoscopy 2013; 45: E422–E423
胃憩室为罕见病,文献约有 200 例报道 ,发病率低,无明显性别及年龄差异,大部分患者无症状,可并发穿孔及出血等。胃憩室可为先天性或后天性 ,前者为真憩室,约占 72%,常位于食管胃连接处 2-3cm 范围内,其发生与胎儿畸形或胚胎发育中断有关;后者为假憩室,仅被覆粘膜层,发生可能与胃出口梗阻、反复呕吐、急性胆囊炎、胰腺炎及肝、脾黏连有关。对于有症状患者,建议行手术切除,腹腔镜下憩室切除术为首选。
相似病例推荐
空肠憩室穿孔
2015-08-12阅读量:2787
![](http://web.medlinker.com/assets/temp/casem/143939290338941.jpg)
胃憩室穿孔致出血
2015-06-21阅读量:2621
![](http://imgs.s0.medlinker.net/casem/201506/21/143486350120813.png)
胃穿孔1例
2016-02-22阅读量:2084
共0评论最早评论
没有更多数据了