Bright Elizabeth, Fishwick Guy, Berry David, Thomas Michael
Leicester General Hospital, Leicester, UK.
Case Rep Gastroenterol. 2008 Nov 5;2(3):351-5. doi: 10.1159/000155147.
A 79-year-old male was transferred to the intensive care unit for postoperative respiratory support. An indwelling bowel management system was inserted for containment of noninfective diarrhoea. Following only 11 days of continual use the patient developed life-threatening rectal bleeding. Preoperative normal rectal mucosa and anatomy were documented. There was no evidence of postoperative coagulopathy. Mesenteric angiography identified bleeding from a branch of the superior rectal artery. Rectal mucosa pressure necrosis secondary to the indwelling Flexi-Seal® Fecal Management System was diagnosed. The patient required an 11-unit transfusion of packed red cells. Following intraarterial coil embolization of the superior rectal artery the bleeding abated. Indwelling bowel management systems are commonly used in immobile and critically ill patients with diarrhoea or faecal incontinence. This is the first report of this important complication in the literature.
一名79岁男性因术后呼吸支持被转入重症监护病房。为控制非感染性腹泻插入了一个留置肠道管理系统。仅持续使用11天后，患者就出现了危及生命的直肠出血。术前记录了直肠黏膜和解剖结构正常。没有术后凝血功能障碍的证据。肠系膜血管造影显示直肠上动脉的一个分支出血。诊断为留置Flexi-Seal®粪便管理系统继发直肠黏膜压迫性坏死。患者需要输注11单位浓缩红细胞。直肠上动脉动脉内线圈栓塞术后出血停止。留置肠道管理系统常用于不能活动的重症腹泻或大便失禁患者。这是文献中关于这一重要并发症的首例报告。
