Damianov N, Hristova K, Burud I, Drandarska I
Khirurgiia (Sofiia). 2010(4-5):42-5.
This 81 years old man with chronic obstructive pulmonary disease (COPD), chronic sepsis, chronic renal failure dependent on mechanical ventilation presented in the course of treatment with massive lower gastrointestinal bleeding (LGIB). Selective angiography of inferior mesenteric artery was performed 18 hours after first bleeding and localized source of bleeding at the distal colon as a contrast in the lumen of the gut. Direct intraarterial injection of 3.4 micrograms Vasopressin was carried out in inferior mesentery artery for preparation of surgery. During surgery the colonoscopy was done and despite of the high operative risk total colectomy with ileostomy was performed. This case confirms that there are not alternatives of colectomy in continuing LGIB from colonic diverticula even in the high risk patients.
这位81岁男性患有慢性阻塞性肺疾病（COPD）、慢性脓毒症、依赖机械通气的慢性肾衰竭，在治疗过程中出现大量下消化道出血（LGIB）。首次出血18小时后进行了肠系膜下动脉选择性血管造影，确定出血源位于结肠远端，表现为肠道腔内造影剂显影。为手术做准备，在肠系膜下动脉内直接动脉注射了3.4微克血管加压素。手术期间进行了结肠镜检查，尽管手术风险很高，但仍进行了全结肠切除术并做了回肠造口术。该病例证实，即使是高危患者，对于结肠憩室持续出血的情况，全结肠切除术没有其他替代方案。
