Ina Shinomi, Tani Masaji, Takifuji Katsunari, Yamazoe Shinji, Nakatani Yoshihiro, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):491-3.
A 76-year-old man was admitted to our hospital with abdominal pain, nausea, and vomiting. The patient was diagnosed as ileus by abdominal radiography, which showed an enlarged bowel and an air-fluid level. Computed tomography of the abdomen showed a thickened intestinal wall. His general status suddenly worsened, and he was placed on a respirator and catecholamines to prevent acute respiratory distress syndrome, septic shock, and disseminated intravascular coagulation. He had continuous fresh anal bleeding. Total colonoscopy showed bloody stool originating from the ileum. Emergency operation was performed for hemorrhagic shock under general anesthesia. Intraoperative jejunal endoscopy revealed deep linear ulcers with bleeding in the jejunum, and 30 cm of the jejunum was resected. Histopathologic examination revealed cytomegalic cells with intranuclear inclusion bodies in the tissues surrounding the ulcers, and it was diagnosed as cytomegaloviral enterocolitis with hemophagocytic syndrome in a non-compromised adult.
一名76岁男性因腹痛、恶心和呕吐入院。腹部X线检查显示肠管扩张和气液平面，诊断为肠梗阻。腹部计算机断层扫描显示肠壁增厚。患者一般状况突然恶化，为预防急性呼吸窘迫综合征、感染性休克和弥散性血管内凝血，给予其呼吸机支持及使用儿茶酚胺类药物。患者持续出现新鲜肛门出血。全结肠镜检查显示便血源自回肠。在全身麻醉下因失血性休克行急诊手术。术中空肠内镜检查发现空肠有伴有出血的深部线性溃疡，切除了30厘米的空肠。组织病理学检查显示溃疡周围组织中有含核内包涵体的巨细胞，诊断为非免疫功能低下成人的巨细胞病毒性小肠结肠炎合并噬血细胞综合征。
