華山論劍-專業案例挑戰/Case 2014-001

Date: 18 Feb posted by 陳志城/王文倫/李青泰/張吉仰/牟聯瑞醫師學術天地

A 20-year-old with abdominal pain and diarrhea for 1 week

This 20 year-old young man was a soldier without systemic disease before. He suffered from peri-umbilical pain for one week with intermittent tarry stool, which exacerbated after meals. He did not have fever, chills or diarrhea. EGD study at local hospital revealed gastric ulcers and duodenal ulcers. Despite medical treatment, his symptoms further progressed. On physical exam, hypoactive bowel sound and diffuse abdominal tenderness were noted. Neither skin rash nor rebounding pain were found. The stool exam showed positive pus cells and occult blood test.

After admission, Ciprofloxacin were prescribed empirically for infectious enterocolitis. However, progressive abdominal distention and persistent abdominal pain were noted. The plain film of abdomen and lab exam were showed as below.

Abdominal echo showed bowel wall thickening at the 3rd portion of duodenum and jejunum. Abdominal CT showed suspected inflammatory process over jejunum with mild ascites.

In order to clarify the etiology of small bowel lesion, single balloon enteroscopy was arranged.

Small Bowel enteroscopy (Video)



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