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Expedited evaluation of atypical aortic dissection with point of care ultrasound: A case report 快速评价非典型主动脉夹层的护理点超声：1例报告

JEM reports

Pub Date : 2025-07-26 DOI: 10.1016/j.jemrpt.2025.100189

Reginald J. Myles , Addison B. Smartt , Patrick Kishi , Lauren B. Querin , Douglas Rappaport , Cody Petrie

Background

Aortic dissection (AD) is a vascular emergency with substantial morbidity and mortality. Aortic dissections have been classically categorized into two subtypes: Stanford Type A aortic dissections involve the ascending aorta and/or aortic arch and require emergent surgical intervention. Stanford Type B aortic dissections involve the aortic arch distal to the left subclavian artery and descending aorta and can be managed medically. Despite its dire consequences, Type A dissections remain challenging to diagnose due to highly variable clinical presentations. While imaging modalities such as magnetic resonance imaging (MRI), computed tomography angiography (CTA), and transesophageal echocardiography (TEE) have high diagnostic sensitivity, they are time-intensive and may delay treatment initiation.

Case report

This case report describes the rapid diagnosis and management of a 47-year-old male patient presenting with atypical symptoms of aortic dissection, including vague chest tightness and progressive global encephalopathy. Bedside point-of-care ultrasound (POCUS) played a pivotal role in initiating timely diagnosis, intervention, and improving the clinical outcome of this patient with a Stanford Type A aortic dissection.

Why should an emergency physician be aware of this?

POCUS can provide valuable early diagnostic insights and expedite further evaluation of Stanford Type A aortic dissection. Especially in cases of atypical presentation, POCUS is a rapid and inexpensive diagnostic tool for this highly emergent and morbid condition, accelerating further definitive imaging and treatment.

背景：主动脉夹层（AD）是一种发病率和死亡率都很高的血管急症。主动脉夹层被经典地分为两种亚型：Stanford A型主动脉夹层涉及升主动脉和/或主动脉弓，需要紧急手术干预。斯坦福B型主动脉夹层涉及左锁骨下动脉和降主动脉远端主动脉弓，可以进行医学治疗。尽管其可怕的后果，A型解剖仍然具有挑战性的诊断，由于高度可变的临床表现。虽然磁共振成像（MRI）、计算机断层血管造影（CTA）和经食管超声心动图（TEE）等成像方式具有很高的诊断敏感性，但它们需要耗费大量时间，可能会延迟治疗的开始。本病例报告描述了一名47岁男性患者的快速诊断和处理，该患者表现为不典型的主动脉夹层症状，包括模糊胸闷和进行性全身性脑病。床边点超声（POCUS）在及时诊断、干预和改善斯坦福a型主动脉夹层患者的临床预后方面发挥了关键作用。急诊医生为什么要意识到这一点？POCUS可以提供有价值的早期诊断见解并加快对Stanford A型主动脉夹层的进一步评估。特别是在不典型的情况下，POCUS是一种快速和廉价的诊断工具，用于这种高度紧急和病态的情况，加速进一步的明确成像和治疗。

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引用次数: 0

Elevated lung cancer screening needs among emergency department patients 急诊科患者肺癌筛查需求增加

JEM reports

Pub Date : 2025-07-26 DOI: 10.1016/j.jemrpt.2025.100188

Beau Abar, George Ashji, David Adler

Background

More than 10 % of Emergency Department (ED) cancer-related visits are for lung cancer. Timely lung cancer screening is an effective mechanism to decrease lung cancer morbidity and mortality, but only 16 % of eligible patients in the general population are up-to-date with lung cancer screening recommendations. Furthermore, many characteristics found predictive of non-adherence with screening are over-represented within the ED patient population.

Objective

The goal of this study is to determine risk for non-adherence with USPSTF lung cancer screening guidelines among the ED patient population.

Methods

Data on smoking history and lung cancer screening were abstracted from the medical charts of patients 50–80 years old presenting to the University of Rochester Medical Center ED during 2023. Adherence with guidelines among eligible patients was determined by documentation of lung cancer screening in the year prior to ED presentation. We also evaluated any screening that occurred within 120 days of their ED visit.

Results

A total of 559 patient charts were reviewed, with 354 having a documented history of tobacco use (63 %). Pack year estimates were available for 252 patients, and 116 patients had a 20+ pack year smoking history documented (e.g., eligible for lung cancer screening). Among those, 14 individuals received LCS in the past year, representing a screening adherence rate of 12 % at presentation. By 120 days post-visit, the rate declined to 9 %.

Conclusion

ED patients are at elevated risk for non-adherence with LCS guidelines, supporting previous work that demonstrates the potential value of ED-based intervention efforts.

背景：超过10%的急诊科（ED）癌症相关就诊是针对肺癌。及时的肺癌筛查是降低肺癌发病率和死亡率的有效机制，但在普通人群中，只有16%的符合条件的患者接受了最新的肺癌筛查建议。此外，在ED患者群体中，发现许多预测筛查不依从性的特征被过度代表。目的本研究的目的是确定ED患者人群中不遵守USPSTF肺癌筛查指南的风险。方法从罗彻斯特大学医学中心急诊部2023年就诊的50 ~ 80岁患者病历中提取吸烟史和肺癌筛查资料。符合条件的患者是否遵守指南是通过ED出现前一年的肺癌筛查记录来确定的。我们还评估了他们在急诊室就诊后120天内进行的任何筛查。结果共审查559例患者病历，其中354例（63%）有烟草使用史。252名患者可获得包年估计，116名患者有超过20包年的吸烟史记录（例如，符合肺癌筛查条件）。其中，14人在过去的一年中接受了LCS，代表了12%的筛查依从率。到120天后，这一比例降至9%。结论：患者不遵守LCS指南的风险较高，支持先前的研究，证明了基于ed的干预措施的潜在价值。

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引用次数: 0

Point-of-care ultrasound stratified by the wells score for the diagnosis of proximal deep vein thrombosis: A prospective study 现场超声分层的井评分诊断近端深静脉血栓：一项前瞻性研究

JEM reports

Pub Date : 2025-07-26 DOI: 10.1016/j.jemrpt.2025.100187

Nicolás Rojas Muñoz , Hans Clausdorff Fiedler , Felipe Riquelme Morales , Victor Vidal Zamorano , Francisca Seydewitz Osses , Sofía Rivera Gonzalez , Carlos Basaure Verdejo

Background

Deep vein thrombosis (DVT) affects 1 in 1000 people, with complications associated both in under and over diagnosis. Duplex ultrasound is the gold standard but its use in emergency settings is limited. Two-point Point-of-Care ultrasound protocol performed by emergency physicians can foster its diagnosis. However, 6 % of cases can be missed and its performance stratified by clinical pre-test probability is unknown.

Objective

To evaluate the diagnostic performance of an extended compression ultrasound (ECUS) protocol performed by emergency physicians when stratified by Wells score.

Methods

We conducted a prospective diagnostic accuracy study. Adult patients (≥18 years) with suspected DVT were stratified by Wells score (low, intermediate, high risk) and underwent ECUS by trained emergency physicians or residents. Results were compared to complete duplex ultrasound (CDUS) performed by radiologists within 24 h.

Results

Among 194 patients analyzed (54 % female, mean age 61 ± 18 years), the overall prevalence of proximal DVT was 17 %. The ECUS protocol demonstrated a global sensitivity of 97 % (95 % CI: 84.2–99.9), specificity of 94.4 % (95 % CI: 89.7–97.4), positive predictive value of 78.6 % (95 % CI: 63.2–89.4), and negative predictive value of 99.3 % (95 % CI: 96.4–100). In the low-risk group, sensitivity was 100 % (95 % CI: 29.2–100) with a negative predictive value of 100 % (95 % CI: 90.7–100).

Conclusion

The combined use of Wells score stratification and ECUS can reliably exclude proximal DVT in low and intermediate-risk patients, potentially optimizing emergency department resources and facilitating timely clinical decisions. In low-risk patients, this strategy may yield results comparable to comprehensive Doppler ultrasound.

深静脉血栓（DVT）每1000人中就有1人患病，其并发症与诊断不足和诊断过度有关。双工超声是黄金标准，但它在紧急情况下的应用是有限的。由急诊医生执行的两点护理超声协议可以促进其诊断。然而，6%的病例可能被遗漏，其表现分层的临床前测试概率是未知的。目的评价急诊医师采用扩展压缩超声（ECUS）方案对威尔斯评分分层的诊断价值。方法进行前瞻性诊断准确性研究。疑似DVT的成年患者（≥18岁）按Wells评分（低、中、高风险）分层，由训练有素的急诊医生或住院医师进行ECUS。结果分析194例患者（女性54%，平均年龄61±18岁），近端DVT总患病率为17%。ECUS方案的总体敏感性为97% (95% CI: 84.2-99.9)，特异性为94.4% (95% CI: 89.7-97.4)，阳性预测值为78.6% (95% CI: 63.2-89.4)，阴性预测值为99.3% （95% CI: 96.4-100）。在低危组，敏感性为100% (95% CI: 29.2-100)，阴性预测值为100% （95% CI: 90.7-100）。结论威尔斯评分分层与ECUS联合应用可可靠地排除中低危患者近端DVT，可优化急诊科资源，促进临床及时决策。在低风险患者中，这种策略可能产生与综合多普勒超声相当的结果。

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引用次数: 0

A rare complication of thoracotomy: thoracodorsal artery pseudoaneurysm 开胸手术的罕见并发症：胸背动脉假性动脉瘤

JEM reports

Pub Date : 2025-07-23 DOI: 10.1016/j.jemrpt.2025.100186

Mustafa Koyun , Bahadir Reis

Background

Pseudoaneurysms are pathological formations that can develop after trauma, inflammation, or surgery, with symptoms sometimes emerging following a latent period.

Case report

This paper examines a 66-year-old female patient with a history of thoracotomy for descending aortic aneurysm repair who presented to the emergency department with swelling and loco-regional pain in the left lateral chest wall. The patient was referred to the radiology unit with suspected abscess in the left chest wall. Ultrasonography (US) and color Doppler US (CDUS) revealed a thoracodorsal artery pseudoaneurysm in the area thought to be an abscess. This paper presents the radiological findings of this previously undocumented late complication of thoracotomy and emphasizes the importance of considering vascular complications in patients presenting with chest wall swelling.

Why should an emergency physician be aware of this?

Emergency physicians must recognize that post-thoracotomy chest wall swellings could be pseudoaneurysms rather than abscesses or hematomas. Careful physical examination detecting pulsation or bruit should prompt vascular imaging. Familiarity with characteristic ultrasonographic findings ("yin-yang" sign, "to-and-fro" flow pattern) facilitates accurate diagnosis. Mismanagement, such as incision of a misdiagnosed pseudoaneurysm, may cause catastrophic hemorrhage. Maintaining high suspicion in patients with thoracic surgical history ensures appropriate vascular surgery referral.

假性动脉瘤是可在创伤、炎症或手术后发生的病理性形成，症状有时在潜伏期后出现。病例报告：本文报告了一位66岁的女性患者，有开胸手术治疗降主动脉瘤的病史，因左胸壁肿胀和局部区域疼痛而就诊于急诊室。病人因怀疑左胸壁有脓肿而转诊至放射科。超声（US）和彩色多普勒超声（CDUS）显示胸背动脉假性动脉瘤的区域认为是一个脓肿。本文介绍了这种先前未记载的开胸晚期并发症的影像学表现，并强调了在胸壁肿胀患者中考虑血管并发症的重要性。急诊医生为什么要意识到这一点？急诊医生必须认识到，开胸后胸壁肿胀可能是假性动脉瘤，而不是脓肿或血肿。仔细的体格检查发现搏动或瘀伤应提示血管成像。熟悉特征性超声表现（“阴阳”征，“来回”流型）有助于准确诊断。处理不当，如切开误诊的假性动脉瘤，可能导致大出血。对有胸外科病史的患者保持高度怀疑，以确保适当的血管手术转诊。

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引用次数: 0

When the scan tells a different story 但扫描结果却不一样

JEM reports

Pub Date : 2025-07-19 DOI: 10.1016/j.jemrpt.2025.100185

Matthew S. Berniard, Monika Krzak, Richard Slama, Charles Dalton Hardesty, Carlo Zamora, Christina Cartwright

Background

Point-of-care ultrasound (POCUS) has become a standard in emergency care for its rapid, accurate bedside diagnostics and procedural guidance. Our institution developed a tailored, comprehensive POCUS course aligned with American Board of Emergency Medicine guidelines. Unlike many physician-only programs, our course also trains Advanced Practice Providers (APPs) alongside their supervising physicians. Two weeks after completing the course, an APP applied this training in a rare case, directly contributing to a life-saving intervention. While not a substitute for residency-based ultrasound training, this experience highlights the powerful impact of structured ultrasound education for all emergency providers.

Case report

A 33-year-old male presented to the emergency department (ED) with progressively worsening, atraumatic, right knee and calf pain over a two-week period leading to difficulty ambulating. Initially evaluated by an APP in the low-acuity area, a supervising physician was consulted to proctor and perform a proximal lower extremity POCUS for suspected deep vein thrombosis (DVT). While no DVT was identified, the scan revealed a 3.8 cm arterial structure consistent with a massive popliteal artery aneurysm. Computed Tomography Angiography confirmed the diagnosis and raised concern for rupture. The patient was taken emergently for bypass surgery. Investigation revealed the aneurysm was secondary to tertiary syphilis in the setting of undiagnosed human immunodeficiency virus (HIV).

Why should an emergency physician be aware of this?

Emergency Medicine physicians should embrace the broad utility of ultrasound as a rapid, accurate, and cost-effective diagnostic tool that enhances patient care, especially in resource-limited settings. This case underscores ultrasound's role in the timely diagnosis and treatment of vascular emergencies, while highlighting the need for comprehensive ultrasound training programs inclusive of all provider types.

护理点超声（POCUS）因其快速、准确的床边诊断和程序指导已成为急诊护理的标准。我们的机构根据美国急诊医学委员会的指导方针制定了量身定制的综合POCUS课程。与许多仅限医生的课程不同，我们的课程还培训高级实践提供者（app）以及他们的指导医生。在完成课程两周后，一个APP在一个罕见的案例中应用了这种培训，直接有助于挽救生命的干预。虽然不能替代住院医师超声培训，但这一经验强调了结构化超声教育对所有急诊提供者的强大影响。病例报告：一名33岁男性，因右膝和小腿疼痛逐渐加重，非创伤性疼痛持续两周，导致行走困难而就诊于急诊科。最初通过APP在低视力区域进行评估，咨询了一名监督医生，为疑似深静脉血栓（DVT）进行了近端下肢POCUS检查。虽然没有发现深静脉血栓，但扫描显示3.8厘米的动脉结构与巨大的腘动脉动脉瘤一致。计算机断层血管造影证实了诊断，并引起了对破裂的关注。病人被紧急送去做搭桥手术。调查显示动脉瘤继发于未确诊的人类免疫缺陷病毒（HIV）的三期梅毒。急诊医生为什么要意识到这一点？急诊医师应该接受超声作为一种快速、准确、成本效益高的诊断工具的广泛应用，尤其是在资源有限的情况下。本病例强调了超声在及时诊断和治疗血管紧急情况中的作用，同时也强调了对包括所有提供者类型在内的综合超声培训计划的需求。

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引用次数: 0

Immune checkpoint inhibitor-associated polyneuropathy in malignant pleural mesothelioma: A case report 恶性胸膜间皮瘤中免疫检查点抑制剂相关的多神经病变：1例报告

JEM reports

Pub Date : 2025-07-18 DOI: 10.1016/j.jemrpt.2025.100184

Mehdi Kashani , Colleen Leu-Turner , Douglas E. Rappaport , James Kelley (Senior Author)

Background

Immune checkpoint inhibitors (ICIs), such as nivolumab and ipilimumab, have revolutionized treatment for malignant pleural mesothelioma (MPM) but may cause rare, immune-related neurological adverse events.

Case presentation

A 71-year-old man with recurrent MPM developed rapidly progressive weakness, sensory loss, and neuropathic pain following his second cycle of nivolumab/ipilimumab. Workup ultimately revealed inflammatory demyelinating and axonal polyradiculoneuropathy. Cerebrospinal fluid analysis supported an autoimmune process. High-dose corticosteroids and intravenous immunoglobulin (IVIG) were initiated, resulting in functional improvement. He was discharged on a steroid taper with outpatient follow-up.

Why should an emergency physician be aware of this?

This case highlights the importance of recognizing immune-mediated polyneuropathy as a potential complication of ICI therapy. Timely diagnosis, multidisciplinary care, and early immunosuppressive treatment can lead to meaningful recovery.

免疫检查点抑制剂（ICIs），如nivolumab和ipilimumab，已经彻底改变了恶性胸膜间皮瘤（MPM）的治疗，但可能导致罕见的免疫相关神经系统不良事件。病例介绍：一名71岁男性复发性MPM患者在第二次纳武单抗/伊匹单抗治疗后出现了快速进行性虚弱、感觉丧失和神经性疼痛。最终检查显示炎症性脱髓鞘和轴突性多根神经病变。脑脊液分析支持自身免疫过程。开始使用大剂量皮质类固醇和静脉注射免疫球蛋白（IVIG），导致功能改善。他出院后接受类固醇减量治疗，门诊随访。急诊医生为什么要意识到这一点？本病例强调了认识到免疫介导的多神经病变作为ICI治疗的潜在并发症的重要性。及时诊断、多学科护理和早期免疫抑制治疗可导致有意义的康复。

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引用次数: 0

All choked up; male with foreign body sensation 大家都哽咽了；男性有异物感

JEM reports

Pub Date : 2025-07-12 DOI: 10.1016/j.jemrpt.2025.100183

Harrison Barnhart, Gordon Tse, Norman Ng, Amin Mohamadi, Barry Hahn

引用次数: 0

Leech infestation-a rare cause of upper gastrointestinal bleeding: A case report 水蛭感染——上消化道出血的罕见原因：1例报告

JEM reports

Pub Date : 2025-07-05 DOI: 10.1016/j.jemrpt.2025.100182

Mengesha Akale , Dawit Zena , Fitsum Mesfin , Nahom Addisu

Background

Leeches are rare blood-sucking endoparasites found in fresh water and can cause potentially life-threatening complications. Leech infestations are an uncommon cause of upper gastrointestinal bleeding, often presenting diagnostic challenges and rarely considered in the differential diagnosis. The available literature on leech infestation is limited.

Case presentation

A 20-year-old woman from rural Ethiopia presented with bloody vomiting and spitting of saliva mixed with blood of 6 days duration. There was bright red blood over the posterior part of the tongue, palate, and oropharynx. An endoscopy revealed a motile dark brown worm in the hypopharynx, specifically in the pyriform sinus, along with active bleeding. Under conscious sedation, a 5 cm long leech was removed gently using nontoothed forceps. Bleeding was stopped immediately and patient discharged in stable condition.

背景：水蛭是一种在淡水中发现的罕见的吸血内寄生虫，可引起潜在的危及生命的并发症。水蛭感染是一种罕见的上消化道出血的原因，往往提出诊断挑战，很少考虑在鉴别诊断。关于水蛭侵扰的文献是有限的。病例表现一名来自埃塞俄比亚农村的20岁妇女出现血性呕吐和吐口带血唾液，持续6天。舌后部、上颚和口咽部有鲜红色的血。内窥镜检查显示下咽，尤其是梨状窦内有一条活动的深棕色蠕虫，并伴有活动性出血。在清醒镇静下，用无齿钳轻轻地取出5厘米长的水蛭。立即止血，出院时病情稳定。

引用次数: 0

When booming in the ears is more than benign tinnitus 当耳鸣时多为良性耳鸣

JEM reports

Pub Date : 2025-06-26 DOI: 10.1016/j.jemrpt.2025.100181

Bryan Kharbanda, Nicholas San Roman

Background

Patients commonly present to the emergency department (ED) after initial outpatient evaluations fail to achieve timely diagnosis or symptom control. Many subjective-seeming neurologic symptoms affect a large portion of the US population at least once in a patient's lifetime (tinnitus 15 %, dizziness 30 %, and vertigo 40 %) but remain a diagnostic and treatment challenge for physicians. The ED in the United States plays a major role in risk stratifying these complex patients.

Case presentation

A 49-year-old woman with history of hypertension presents to the ED complaining of hearing a “booming” sensation synchronous with her pulse in her right ear for weeks. She was initially evaluated by her primary care physician and diagnosed “possible tinnitus” and referred to ENT. There, she received an audiogram deemed “normal.” Weeks after her initial evaluation, she mentioned new and progressing symptoms of dizziness to her primary care physician who thus referred her to the ED. In the ED, the patient was found to be hypertensive, anxious, and with slight ataxia. CT angiography of the head and neck found complete occlusion of the left internal carotid throughout the entire left cervical region. The patient was started on heparin, anti-hypertensive medications, and transferred to a comprehensive stroke center after discussion with their neuro-interventionalist.

Why should an emergency physician be aware of this?

Pulsatile tinnitus (PT) is rare but the causative differential diagnosis is vast and may be complex. PT should be considered an otologic symptom rather than its own diagnosis. Recent data suggests that an underlying cause can be identified in about 70 % of PT cases through proper diagnostic work-up (6). Failure to recognize the need for further work-up and diagnostics could lead to significant morbidity and mortality. Early recognition is crucial as treatment options are available to mitigate permanent neurologic deficits or death for dangerous causes. The treatment options vary markedly, however, depending on the ultimate etiology for PT. Accurate and timely diagnosis entirely drive effective management of pulsatile tinnitus.

背景：患者通常在初次门诊评估后出现在急诊科（ED），无法获得及时诊断或症状控制。许多看似主观的神经系统症状影响了很大一部分美国人，在他们的一生中至少有一次（耳鸣15%，头晕30%，眩晕40%），但对医生来说仍然是诊断和治疗的挑战。在美国，急诊科在对这些复杂患者进行风险分级方面起着重要作用。病例表现一名49岁女性，有高血压病史，到急诊科就诊，主诉数周以来右耳有与脉搏同步的“轰鸣声”。她最初由她的初级保健医生进行了评估，诊断为“可能的耳鸣”，并转介到耳鼻喉科。在那里，她接受了“正常”的听力图检查。初步评估几周后，她向主治医生提及头晕的新症状和进展症状，主治医生因此将她转至急诊科。在急诊科，发现患者有高血压、焦虑和轻微共济失调。头部和颈部的CT血管造影发现左侧颈内动脉完全闭塞，覆盖整个左侧颈椎区域。患者开始使用肝素和抗高血压药物，并在与神经介入医生讨论后转移到综合中风中心。急诊医生为什么要意识到这一点？搏动性耳鸣（PT）是罕见的，但病因的鉴别诊断是广泛的，可能是复杂的。PT应被视为一种耳科症状，而不是其本身的诊断。最近的数据表明，通过适当的诊断检查，可以在大约70%的PT病例中确定潜在原因(6)。未能认识到进一步检查和诊断的必要性可能导致严重的发病率和死亡率。早期识别是至关重要的，因为治疗方案可以减轻永久性神经功能缺损或危险原因导致的死亡。然而，根据PT的最终病因，治疗方案明显不同。准确和及时的诊断完全推动了搏动性耳鸣的有效管理。

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引用次数: 0

Small bowel obstruction caused by hiatal hernia 裂孔疝引起的小肠梗阻

JEM reports

Pub Date : 2025-06-25 DOI: 10.1016/j.jemrpt.2025.100180

Jacob Cabrejas, Kara Zweerink, Wesley Eilbert

Background

A hiatal hernia is caused by herniation of a portion of the stomach or other abdominal viscera into the thorax through the esophageal hiatus of the diaphragm. It is a common condition and asymptomatic in most cases.

Case report

We present the case of a 52-year-old male with a past medical history of previous hiatal hernia repair who presented to the emergency department with one day of diffuse abdominal pain and multiple episodes of emesis. Bowel sounds were heard on auscultation of his left chest. Computed tomography of the abdomen and pelvis demonstrated multiple abdominal contents herniating through the esophageal hiatus. Multiple dilated loops of small bowel were seen in the left hemithorax with decompressed small bowel seen more distally, indicating a small bowel obstruction with a transition point in the thoracic cavity.

Why should an emergency physician be aware of this? Hiatal hernia is a common condition. While rare, large hiatal hernias may result in herniation of small bowel with the potential complication of bowel obstruction.

食管裂孔疝是由于胃或其他腹部脏器的一部分通过膈食管裂孔疝入胸腔而引起的。这是一种常见的情况，在大多数情况下无症状。病例报告：我们报告一例52岁男性患者，既往有裂孔疝修补病史，因一天弥漫性腹痛和多次呕吐而就诊急诊。左胸听诊可听到肠音。腹部和骨盆的计算机断层扫描显示多个腹部内容物通过食管裂孔疝出。左半胸可见多个小肠扩张袢，减压的小肠远端可见，提示小肠梗阻，过渡点位于胸腔。急诊医生为什么要意识到这一点？裂孔疝是一种常见的疾病。虽然罕见，但大裂孔疝可导致小肠疝，并有肠梗阻的潜在并发症。

引用次数: 0