Handschin Alexander E, Weber Markus, Weishaupt Dominik, Fried Michael, Clavien Pierre-Alain
Department of Visceral Surgery and Transplantation, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Dis Colon Rectum. 2002 Nov;45(11):1541-4. doi: 10.1007/s10350-004-6463-y.
We report the case of a 62-year-old male with portal hypertension and recurrent bleeding refractory to surgical intervention from varices in a sigmoid stoma. Although stomal varices were detected neither by physical examination, stomal endoscopy, nor duplex sonography, contrast-enhanced three-dimensional magnetic resonance angiography of the portal vein and its collateral branches demonstrated their presence. Surgical revisions of the stoma failed to prevent bleeding, but implantation of a transjugular intrahepatic shunt successfully prevented recurrent hemorrhage. This case indicates that contrast-enhanced, three-dimensional magnetic resonance angiography is useful to detect this rare complication of portal hypertension and helps to tailor adequate treatment in patients with recurrent bleeding from stomal varices.
我们报告了一例62岁男性患者，患有门静脉高压，乙状结肠造口静脉曲张导致反复出血，对手术干预无效。尽管体格检查、造口内镜检查和双功超声均未发现造口静脉曲张，但门静脉及其分支的对比增强三维磁共振血管造影诊断出了造口静脉曲张。造口手术修复未能防止出血，但经颈静脉肝内门体分流术成功预防了再次出血。该病例表明，对比增强三维磁共振血管造影有助于检测这种罕见的门静脉高压并发症，并有助于为造口静脉曲张反复出血的患者制定适当的治疗方案。
