胰十二指肠切除术后临床腹腔疾病的发生：上腹部大手术的一种潜在并发症。
Development of clinical celiac disease after pancreatoduodenectomy: a potential complication of major upper abdominal surgery.
作者信息
Chedid Aljamir D, Kruel Cleber R P, Chedid Marcio F, Torresini Ronaldo J S, Geyer Geraldo R
机构信息
Service of General Surgery, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul-College of Medicine, Porto Alegre, Brazil.
出版信息
Langenbecks Arch Surg. 2005 Feb;390(1):39-41. doi: 10.1007/s00423-004-0516-5. Epub 2004 Sep 24.
BACKGROUND
Celiac disease is a gluten-induced disease of global malabsorption. There is a subset of patients with celiac disease who are free of major symptoms but who have typical damage to the intestinal mucosa (silent disease). We present the case of a 50-year-old white woman with no clinical symptoms of celiac disease who developed diarrhea and weight loss 12 weeks after a pancreatoduodenectomy for ampullary cancer.
METHODS
Microbiological and biochemical examination of the feces did not provide clues useful to diagnosis, and diarrhea was not affected by pancreatic enzyme replacement or administration of antiperistaltic drugs.
RESULTS
Review of the pathologic specimen and blood tests were compatible with celiac disease.
CONCLUSION
This clinical scenario illustrates that subclinical celiac disease may be an underdiagnosed cause of malabsorption after major upper gastrointestinal surgery and should be considered in the differential diagnosis of diarrhea after pancreatoduodenectomy.
背景
乳糜泻是一种由麸质引起的全身性吸收不良疾病。有一部分乳糜泻患者没有主要症状，但肠道黏膜有典型损伤（隐匿性疾病）。我们报告一例50岁白人女性，她没有乳糜泻的临床症状，在因壶腹癌行胰十二指肠切除术后12周出现腹泻和体重减轻。
方法
粪便的微生物学和生化检查未提供有助于诊断的线索，腹泻不受胰酶替代治疗或抗蠕动药物给药的影响。
结果
病理标本复查和血液检查结果与乳糜泻相符。
结论
该临床病例表明，亚临床乳糜泻可能是上消化道大手术后吸收不良的一个未被充分诊断的原因，在胰十二指肠切除术后腹泻的鉴别诊断中应予以考虑。
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