NEJM:脐尿管囊肿感染-案例报道

2016-12-29 xing.T MedSci原创

手术矫正后超过1年,虽然患者有明显的且无相关的脐下脓肿需要切开引流,但她一直很好。

患者为一19个月大女孩,有脊髓脊膜膨出和Ⅱ型Chiari畸形病史,因出现腹痛而就诊。
 
最初的腹部检查正常;然而,在24小时内,脐部出现隆起并伴有红斑(如图A)。白细胞计数升高,中性粒细胞比例较大。
 
腹部CT显示囊性肿块,大小为6.1cm*2cm,从脐延长至膀胱顶(如图B,箭头所指)。肿块与膀胱或脐部均无连接;因此,诊断为脐尿管囊肿。
 

 
给与抗生素治疗,将脓性物质从感染的囊肿内引流出。细菌培养发现大肠埃希菌和凝固酶阴性葡萄球菌生长,用特异性针对这些微生物的抗生素进行治疗。经过引流和一个疗程的抗生素治疗后,切除脐尿管囊肿。
 
这种疾病的鉴别诊断包括脐尿管未闭和部分脐尿管残余。未闭的脐尿管连接膀胱和脐,导致尿液通过脐部排出;一部分脐尿管残留将脐尿管窦和脐部或脐尿管憩室和膀胱连接起来。
 
手术矫正后超过1年,虽然患者有明显的且无相关的脐下脓肿需要切开引流,但患儿情况一直很好。
 
原始出处:
 
Nicholas Potisek, et al. Infected Urachal Cyst. N Engl J Med .December 29, 2016. 


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    2017-03-24 stfoxst
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