2021年 · 第59卷第07期

The patient, a 37-year-old male, was admitted to the emergency department on July 2, 2019 due to "sudden upper abdominal pain after drinking for 6 h". The patient had no history of trauma before the onset of the disease. Emergency physical examination: acute disease, soft abdomen, tenderness in the upper abdomen, mainly in the right upper abdomen, without rebound pain and muscle tension; Hard mass can be palpable in the upper abdomen, which is inactive; Abdominal percussion showed drum sound and mobile voiced sound was negative. A plain CT scan of the abdomen was performed in the emergency department. The results showed that an uneven mass shadow, about 11.3 cm ×4.9 cm in size, was seen in the right anterior of the descending duodenum and the inferior liver margin. The surrounding fat space was turbid, accompanied by bleeding, and a strip shadow was seen extending to the right paracolonic sulcus and iliac fossa (Figure 1）。 Routine blood test: white blood cell count 13.5×10⁹/L, neutrophil percentage 81%, hemoglobin 127 g/L, platelet count 221×10⁹/L, considered as abdominal space-occupying lesion with bleeding, so he was admitted to hospital. The results of enhanced CT examination showed that the extent of the lesion was the same as that of plain CT scan, and the lesion was consistent with the bleeding change, and the space-occupying lesion may be excluded (Figures 2~4). After admission, the patient's vital signs and blood routine were closely monitored, and symptomatic and supportive treatments such as active fluid rehydration, blood transfusion and anti-shock were performed, and the abdominal pain was slightly relieved. After many routine blood tests, the patient's red blood cell count and hemoglobin did not fluctuate significantly. Explain the condition to the patient's family and recommend active surgical exploration to prevent the rupture of the lesion and bleeding that is life-threatening.