Zenda Takahiro, Kaneko Shuichi, Noriki Sakon
Department of Internal Medicine, Tsurugi Municipal Hospital, Hakusan 920-2134, Japan.
Hiroshima J Med Sci. 2010 Dec;59(4):83-5.
A 57-year-old woman was admitted to our hospital because of frequent bloody diarrhea, vomiting, and abdominal cramps. While the patient was diagnosed with norovirus gastroenteritis based on the presence by chance of positive norovirus antigen in the stool samples, endoscopic as well as pathological examinations demonstrated left-sided ischemic colitis. The patient soon recovered solely by supportive treatment. Although it is believed that patients with viral gastroenteritis do not develop bloody diarrhea, the present case suggested that conditions of viral gastroenteritis, such as intensified peristalsis, elevation of the intraluminal gut pressure, hypovolemia, and hemoconcentration might trigger ischemic colitis resulting in bloody diarrhea. Physicians should not exclude the diagnosis of viral gastroenteritis simply by depending on the presence of bloody diarrhea. Further studies to clarify the incidence of ischemic colitis in patients with viral gastroenteritis are indispensable.
一名57岁女性因频繁便血、呕吐和腹部绞痛入院。虽然根据粪便样本中偶然出现的诺如病毒抗原阳性将该患者诊断为诺如病毒胃肠炎，但内镜及病理检查显示为左侧缺血性结肠炎。该患者仅通过支持治疗很快康复。尽管一般认为病毒性胃肠炎患者不会出现便血，但本病例提示，病毒性胃肠炎的一些情况，如蠕动增强、肠腔内压力升高、血容量减少和血液浓缩等，可能引发缺血性结肠炎导致便血。医生不应仅根据便血就排除病毒性胃肠炎的诊断。进一步研究以明确病毒性胃肠炎患者中缺血性结肠炎的发病率是必不可少的。
