Case3-：A9-Year-OldGirlwithIntermittentAbdominalPain

一个9岁间断性腹痛的女孩

PresentationofCase

Dr.PatriciaM.Guglietta:A9.5-year-oldgirlwithchronicconstipationwasseeninthegastroenterologyclinicofthishospitalbecauseofrecurrentepisodesofabdominalpainwithassociatednonbiliousvomiting.

PatriciaM.Guglietta医生：一名9岁半的慢性医院的消化内科，原因是腹部疼痛反复发作并伴有非胆汁性呕吐。

Thepatienthadbeengenerallywelluntilshewas4yearsofage,whenoccasionalepisodesofabdominalpainbegantooccur.Theseepisodes,whichoccurredafewtimesperyearandwereseparatedbyasymptomaticperiods,weresometimesassociatedwithconstipationornonbloody,nonbiliousvomiting.Neitherfeversnordiarrheaoccurred.Thepatient’sfamilyreportedthesymptomsduringroutineannualexaminationsorotherscheduledorurgentappointmentsatahealthcenteraffiliatedwiththishospital.Polyethyleneglycolwasadministeredintermittentlyforconstipation,withimprovement.

患者既往体健，直到4岁时，偶尔会出现腹痛发作。腹痛每年发作几次，间隔一段无症状期，有时伴有便秘或无血无胆汁性呕吐。既没有发烧也没有腹泻。该患者的家人医院附属健康中心挂门诊或急诊时说了这些症状。间歇性给聚乙二醇以改善便秘。

Whenthepatientwas8yearsofage,asuddenepisodeofsharppainontheleftsideofthechestoccurred,withassociatedtachycardiaandnausea,intheabsenceofprecipitatingfactors.Onexaminationatschool,thepulsewasbeatsperminute;atthehealthcenter,thetemperatureandtheremainderofthephysicalexaminationwerenormal,aswereachestradiographandanelectrocardiogram.Thepatientreturnedhome.Resultsofacardiologicevaluationthatwasperformed2monthslaterwerenormal.

当患者8岁时，突然无诱因出现左胸剧烈疼痛，伴有心动过速和恶心。在学校检查时，脉搏为每分钟次；在卫生中心，体温和其余体检正常，胸部X光片和心电图也正常。患者返回家中。两个月后进行的心脏评估结果正常。

Duringthenext18months,theepisodesofabdominalpainbecamemorefrequent(uptothreeorfourtimesweekly)andoccurredmoreoftenwhenthepatientwasatschoolthanduringweekends.Thepainwastypicallyepigastricandassociatedwithvomiting.Onevaluationwhenthepatientwas8years7monthsofage,aurineculturewassterile,serologictestingforHelicobacterpyloriinfectionwasnegative,andanabdominalradiographshowednoevidenceofobstruction.Polyethyleneglycolandomeprazolewereadministered;theconstipationtransientlydiminishedwhenthemedicationsweretakenregularly.

在接下来的18个月中，腹痛发作变得更加频繁（每周多达三到四次），并且患者上学时发生的发作比周末更为频繁。疼痛通常位于上腹部，并伴有呕吐。在患者8岁7个月大时的一次评估中，尿培养阴性，幽门螺杆菌感染的血清学检查为阴性，腹部X光片未显示肠阻塞的迹象。服用聚乙二醇和奥美拉唑；定期服用药物后便秘会暂时减少。

Whenthepatientwas9years4monthsofage,shewasseenatanurgentcareclinicbecauseofsharp,crampyepigastricpain.Examinationrevealedanormaltemperature,milddiffuseabdominaltenderness,fullnessintheleftlowerquadrantthatwasconsistentwiththepresenceofstool,andnoabdominalguardingorreboundtenderness.Therapywiththelaxativewasresumed,andconstipationdiminished;however,abdominalpainrecurredintermittentlythereafter,alongwithvomiting,whichgavepartialpainrelief.

当患者9岁4个月大时，她因剧烈的腹部痉挛疼痛而被送往急诊。检查发现体温正常，腹部轻度弥漫性压痛，左下象限饱满，提示大便的存在，没有腹部抵触或反跳痛。恢复了泻药的治疗，便秘缓解。然而，此后间歇性地反复出现腹痛和呕吐，从而部分缓解了疼痛。

Onemonthlater,aphysicalexaminationwasnormal.A
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