Friebe M, Allerödder H P, Lüder J, Kindler U
Abteilung für Innere Medizin, Evangelisches Krankenhaus Oberhausen, Germany.
Dtsch Med Wochenschr. 2001 Aug 24;126(34-35):944-6. doi: 10.1055/s-2001-16580.
A 58-year-old man was admitted to our hospital after an acute onset of rectal bleeding. He was known to have had recurrent duodenal ulcerative disease, once with upper gastrointestinal haemorrhage. Clinical examination was remarkable only for rectal bleeding.
After application of a nasogastric tube cherry-red blood was evacuated. Upper endoscopy showed only very small mucosal erosion in the stomach and coloscopy demonstrated several non-bleeding diverticula. Small bowel enteroclysis showed severe diverticulosis of the duodenum and jejunum.
DIAGNOSIS, TREATMENT AND COURSE: We assumed that the extensive duodenojejunal diverticulosis was the most probable cause of this episode of gastrointestinal bleeding because of simultaneous signs of upper and lower gastrointestinal haemorrhage. Because this was the first such episode we preferred a conservative approach. At nineteen months follow-up there was no recurrence of bleeding.
Gastrointestinal hemorrhage is a common cause of hospitalization. After exclusion of the more common bleeding sources small bowel diverticula should be considered as a possible rare cause. Surgical resection of the bleeding bowel part is the procedure of choice, but one of the major problems in such cases is to locate exactly the bleeding site. If the location is uncertain, a more conservative approach may be preferable, especially in haemodynamically stable patients with first-time diverticular bleeding.
一名58岁男性在急性直肠出血发作后入院。已知他患有复发性十二指肠溃疡疾病，曾有一次上消化道出血。临床检查仅发现直肠出血较为明显。
插入鼻胃管后引出樱桃红色血液。上消化道内镜检查仅显示胃内有非常小的黏膜糜烂，结肠镜检查发现多个无出血的憩室。小肠灌肠造影显示十二指肠和空肠有严重的憩室病。
诊断、治疗与病程：由于同时存在上消化道和下消化道出血的迹象，我们认为广泛的十二指肠空肠憩室病是此次胃肠道出血最可能的原因。因为这是首次出现此类情况，我们倾向于采取保守治疗方法。在19个月的随访中，未出现出血复发。
胃肠道出血是住院的常见原因。排除较常见的出血源后，小肠憩室应被视为一种可能的罕见病因。手术切除出血的肠段是首选的治疗方法，但此类病例的主要问题之一是准确确定出血部位。如果位置不确定，更保守的方法可能更可取，尤其是对于首次发生憩室出血且血流动力学稳定的患者。
