Yu Jihan, Kim Biro, Chung Sungjin, Park Cheol Whee, Chang Yoon Sik
Division of Nephrology, St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
BMJ Case Rep. 2010 Oct 28;2010:bcr0920092249. doi: 10.1136/bcr.09.2009.2249.
Ischaemic enteritis is rare in patients with chronic renal failure not on dialysis. Here we report a case of ischaemic enteritis in an 81-year-old woman with chronic renal failure secondary to hypertension (not dialysis dependent) who presented with acute onset of abdominal pain, non-bloody diarrhoea and subsequent oliguria. The abdominal CT with angiography showed diffuse segmental wall thickening and decreased perfusion of the long segment of the ileum, with decreased enhancement of the vessels that supply the distal ileum. The clinical diagnosis of ischaemic enteritis was made. The patient responded initially to total parenteral nutrition and intravenous antibiotics. After the initiation of haemodialysis, because of the oliguria, the ischaemic enteritis progressed to bowel infarction, and an open laparotomy was performed. This report illustrates some of the difficult therapeutic decisions in a patient with ischaemic enteritis and chronic renal failure.
缺血性肠炎在未接受透析的慢性肾衰竭患者中较为罕见。在此，我们报告一例81岁患有高血压继发慢性肾衰竭（非透析依赖）的女性缺血性肠炎病例，该患者表现为突发腹痛、非血性腹泻及随后的少尿。腹部CT血管造影显示回肠长段弥漫性节段性肠壁增厚及灌注减少，供应回肠远端的血管强化减弱。做出了缺血性肠炎的临床诊断。患者最初对全胃肠外营养和静脉用抗生素有反应。开始血液透析后，由于少尿，缺血性肠炎进展为肠梗死，遂行剖腹探查术。本报告阐述了缺血性肠炎合并慢性肾衰竭患者一些艰难的治疗决策。
