華山論劍-專業案例挑戰/Case 2015-003

Date: 5 Apr. posted by 陳子皓/蔡英楠/王文倫/張吉仰/牟聯瑞醫師學術天地

46 years old male with intermittent abdominal pain for 1 month

A 46 years old male with past medical/surgical history significant for laparoscopic cholecystectomy presented with intermittent abdominal pain for one month. Pain had an insidious onset and was characterized as dull aching without specific location or radiation. Tenderness was aggravated by food intake. Associated symptoms included abdominal fullness and body weight loss (4kg in one month). Patient denied fever, chills, nausea/vomiting, bowel habit change, bloody stool passage.

On physical exam, vital signs were stable. Mild pale conjunctiva was noted. There was no abdominal tenderness or rebounding pain. Blood tests showed microcytic anemia. EGD revealed duodenal ulcer scar. Abdominal ultrasound showed small bowel wall thickening. Abdominal CT disclosed stricture over distal ileum. Peranal enteroscopy revealed distal ileum ulcer with luminal stricture.

CBC

Abdominal CT

Peranal enteroscopy

Video Link

Distal ileum ulcer with luminal stricture

Small bowel series

Focal stricture at distal ileum

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