Yuki N, Kubo M, Noro Y, Kasahara A, Hayashi N, Fusamoto H, Ito T, Kamada T
Department of Internal Medicine, Osaka Police Hospital, Japan.
Am J Gastroenterol. 1992 Apr;87(4):514-7.
Jejunal varices are not a common manifestation of portal hypertension. This report describes a 46-yr-old man with recurrent massive gastrointestinal bleeding from jejunal varices arising in an area of adhesions between the intestine and the omentum. The bleeding site was identified by exploratory laparotomy. Medical therapy, including vasopressin infusion via the superior mesenteric artery, was of limited success for controlling acute variceal bleeding. However, jejunal resection and anastomosis resulted in complete resolution of the bleeding, and the patient has experienced no recurrent bleeding over a 3-yr follow-up period. A review of the literature shows that this syndrome is characterized by portal hypertension, generally due to liver cirrhosis; frequently, there is a history of abdominal surgery, and the syndrome presents with hematochezia but without hematemesis. Accurate preoperative diagnosis is often difficult. We propose that bleeding from jejunal varices, though uncommon, should be considered under such clinical conditions.
空肠静脉曲张并非门静脉高压的常见表现。本报告描述了一名46岁男性，因空肠与网膜粘连部位出现的空肠静脉曲张反复发生大量胃肠道出血。通过剖腹探查确定了出血部位。包括经肠系膜上动脉输注血管加压素在内的药物治疗，在控制急性静脉曲张出血方面效果有限。然而，空肠切除及吻合术使出血完全停止，在3年的随访期内患者未再发生出血。文献回顾显示，该综合征的特点是门静脉高压，通常由肝硬化引起；常有腹部手术史，临床表现为便血但无呕血。术前准确诊断往往困难。我们建议，在这种临床情况下，尽管空肠静脉曲张出血不常见，但仍应予以考虑。
