Ross Andrew S, Gasparaitis Arunas, Hurst Roger, Hanauer Stephen B, Rubin David T
Department of Surgery, University of Chicago, IL, USA.
Nat Clin Pract Gastroenterol Hepatol. 2005 Jun;2(6):281-5; quiz 1 p following 285. doi: 10.1038/ncpgasthep0195.
An 18-year-old woman with a history of Crohn's disease presented in January 2004 with severe epigastric pain, nausea and vomiting of 4 hours' duration. The patient was diagnosed with inflammatory bowel disease, thought to be consistent with ulcerative colitis, in March 2003, but had no medical history up until this point. Initial treatment with mesalamine was unsuccessful and she subsequently presented with medically resistant fulminant colitis and required an urgent colectomy in June 2003. Her immediate postoperative course was uneventful and she was discharged on tapering doses of prednisone. In August 2003, an ileoscopy revealed inflamed, mildly ulcerated mucosa, and biopsies were consistent with Crohn's disease. Azathioprine was added to the treatment regimen and the patient tapered off prednisone. At this stage the patient continued to do well clinically up until presentation.
Small bowel series, abdominal CT scan, abdominal ultrasound, exploratory laparotomy.
Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis.
Resection of necrotic bowel, antibiotics and systemic anticoagulation.
一名18岁克罗恩病女性患者于2004年1月就诊，主诉上腹部剧痛、恶心及呕吐4小时。该患者于2003年3月被诊断为炎症性肠病，当时认为符合溃疡性结肠炎，但此前并无病史。最初使用美沙拉嗪治疗未成功，随后她出现了对药物抵抗的暴发性结肠炎，并于2003年6月接受了紧急结肠切除术。术后初期病情平稳，出院时逐渐减少泼尼松剂量。2003年8月，一次回肠镜检查显示黏膜发炎且有轻度溃疡，活检结果符合克罗恩病。治疗方案中加用了硫唑嘌呤，患者逐渐停用泼尼松。在此阶段，直至此次就诊前患者临床情况一直良好。
小肠造影、腹部CT扫描、腹部超声、剖腹探查术。
肠系膜上静脉血栓形成继发急性肠系膜缺血。
切除坏死肠段、使用抗生素及全身抗凝治疗。
