Stein B L, Lamoureux E, Miller M, Vasilevsky C A, Julien L, Gordon P H
Division of Colon and Rectal Surgery, Mortimer B Davis-Jewish General Hospital and McGill University, Montreal, Que.
Can J Surg. 2001 Apr;44(2):113-6.
To describe the etiology and clinical course of acute colitis occurring after flexible endoscopy.
Chart review.
A university teaching hospital.
Eight patients who sought assessment of potential colonic disease.
Colonoscopy in 5 patients and flexible sigmoidoscopy in 3 patients. The indication for endoscopy was screening in 5 patients, cancer surveillance in 2 patients and preoperative evaluation of colon carcinoma in 1 patient.
The relation of presenting symptoms to glutaraldehyde exposure, the response to therapy and the need for further therapy.
All patients had abdominal pain, mucus diarrhea and rectal bleeding within 48 hours after endoscopy. Most patients reported that the symptoms started within 12 hours of the procedure. All patients were confirmed by sigmoidoscopy to have colitis within 72 hours of the first endoscopic procedure. One patient required hospitalization. In the first 7 patients several stool cultures were negative for Clostridium difficile using the cytotoxin assay by the cell culture method. Four patients had negative cultures for Yersinia, Salmonella and Shigella spp. Three patients were treated with metronidazole initially. Two patients underwent endoscopic biopsy and examination of the biopsy specimen showed fibrinoleukocytic exudate and ischemic type injury. One patient underwent the scheduled sigmoid resection within 48 hours of endoscopy for a Dukes' stage B adenocarcinoma. Concomitant acute ischemic colitis limited to the mucosa and submucosa was noted in the resected specimen. Symptoms resolved in all patients and follow-up endoscopy revealed normal mucosa.
The entity of glutaraldehyde-induced colitis should be recognized and special attention should be given during instrument cleansing to minimize the risk of its development.
描述软性内镜检查后发生的急性结肠炎的病因及临床过程。
病历回顾。
一所大学教学医院。
八名寻求评估潜在结肠疾病的患者。
5例患者接受结肠镜检查，3例患者接受乙状结肠镜检查。内镜检查的指征为5例患者进行筛查，2例患者进行癌症监测，1例患者进行结肠癌术前评估。
出现的症状与戊二醛暴露的关系、治疗反应及进一步治疗的必要性。
所有患者在接受内镜检查后48小时内均出现腹痛、黏液便及直肠出血。大多数患者报告症状在检查后12小时内开始出现。所有患者在首次内镜检查后72小时内通过乙状结肠镜检查确诊为结肠炎。1例患者需要住院治疗。在前7例患者中，采用细胞培养法进行细胞毒素检测，艰难梭菌的多次粪便培养均为阴性。4例患者耶尔森菌、沙门菌和志贺菌属培养阴性。3例患者最初接受甲硝唑治疗。2例患者接受内镜活检，活检标本检查显示纤维蛋白白细胞渗出及缺血性损伤。1例患者在内镜检查后48小时内接受了预定的乙状结肠切除术，以治疗Dukes B期腺癌。在切除标本中发现伴有局限于黏膜和黏膜下层的急性缺血性结肠炎。所有患者症状均缓解，随访内镜检查显示黏膜正常。
应认识到戊二醛诱导性结肠炎这一疾病，在器械清洗过程中应给予特别关注，以尽量降低其发生风险。
