Liberski S M, Koch K L, Atnip R G, Stern R M
Department of Medicine, Pennsylvania State University, Hershey.
Gastroenterology. 1990 Jul;99(1):252-7. doi: 10.1016/0016-5085(90)91255-5.
Patients with chronic nausea and vomiting frequently present challenging diagnostic and therapeutic problems. In such patients, gastroparesis of unknown cause, or "idiopathic" gastroparesis, may be the only objective finding. Two middle-aged women with nausea, vomiting, and weight loss of 10 and 26 kg over 6 and 18 months, respectively, were evaluated. Routine laboratory and barium study results were normal. Solid-phase gastric emptying studies showed severe gastroparesis in both patients. Upper endoscopies excluded gastric outlet obstruction. Gastric dysrhythmias (4-cpm and 1-cpm patterns) were recorded using cutaneous electrodes. An abdominal bruit was ascultated in one patient. Abdominal arteriograms in both patients showed total occlusion of all three major mesenteric vessels with collaterals supplied via hemorrhoidal arteries. Bypass grafting procedures of the celiac and superior mesenteric arteries in one patient and of the celiac artery in the other patient were performed. Six months after mesenteric artery revascularization, upper gastrointestinal symptoms had resolved and original weights were regained. Furthermore, normal 3-cpm gastric myoelectrical activity and normal gastric emptying of solids were restored in both patients. In these patients, chronic mesenteric ischemia resulted in a novel and reversible cause of gastroparesis, gastric dysrhythmias, and accompanying symptoms.
慢性恶心和呕吐患者常常会出现具有挑战性的诊断和治疗问题。在此类患者中，病因不明的胃轻瘫，即“特发性”胃轻瘫，可能是唯一的客观发现。对两名中年女性进行了评估，她们分别在6个月和18个月内出现恶心、呕吐，体重减轻了10千克和26千克。常规实验室检查和钡餐检查结果均正常。固相胃排空研究显示两名患者均有严重的胃轻瘫。上消化道内镜检查排除了胃出口梗阻。使用皮肤电极记录到胃节律紊乱（4次/分钟和1次/分钟模式）。一名患者可闻及腹部血管杂音。两名患者的腹部动脉造影均显示所有三支主要肠系膜血管完全闭塞，通过痔动脉提供侧支循环。对其中一名患者进行了腹腔干和肠系膜上动脉搭桥移植手术，对另一名患者进行了腹腔干动脉搭桥移植手术。肠系膜动脉血运重建6个月后，上消化道症状消失，体重恢复至原来水平。此外，两名患者均恢复了正常的3次/分钟胃肌电活动和正常的固体胃排空。在这些患者中，慢性肠系膜缺血导致了一种新的、可逆转的胃轻瘫、胃节律紊乱及伴随症状的病因。
