NEJM临床医学影像脊髓损伤患者的
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ImagesinClinicalMedicineNeurogenicMegacoloninSpinalCordInjuryRukmaR.Govindu,MichelleKelleyNEnglJMed;:e45DOI:10./NEJMicmCopyright?MassachusettsMedicalSociety.A44-year-oldmanwitha20-yearhistoryofquadriplegiafromagunshotwoundtotheneckpresentedtotheemergencydepartmentwithsymptomsofaurinarytractinfection.Hismedicalhistoryincludedchronicmegacolonandneurogenicbladder,andhehadbeenadmittedtothehospitalmanytimesforthemanagementofurinarytractinfectionsandconstipation.Onphysicalexamination,hisabdomenwasdistended,soft,nontender,andtympanictopercussion,withnormalbowelsounds.Extremelylarge,intermittentwavesofperistalsiswerenoted(seevideo),andthepatientreportedmildcrampingandabloatingsensationinassociationwiththisfinding.Computedtomographyoftheabdomenrevealedmassivedilatationofthetransverse(PanelsAandB),descending,andsigmoidcolonofupto18cm.Therewasalsoasubstantialfecalburdenasaresultofneurogenicdysfunction(PanelsAandB,asterisks).Stoolsoftenersandlaxativeswereadministered,andthepatientwastoldtoavoidantimotilityagents.Megacolonisprevalentinpatientswithspinalcordinjuries,especiallyinolderpatientsandinthosewithinjuriesthathavebeenpresentformorethan10years.Complicationsofmegacolonincludeabdominal怎么治愈白癜风治疗白癜风哪家效果最好
