Guisado Vasco P, Fraile Rodríguez G
Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
Rev Clin Esp (Barc). 2014 Jan-Feb;214(1):26-30. doi: 10.1016/j.rce.2013.07.011. Epub 2013 Sep 12.
We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy.
我们研究了一名因蛋白丢失性肠病继发水肿以及因肠道不全梗阻发作继发反复腹胀和腹痛的患者。经过临床研究,该患者被诊断为隐源性多灶性溃疡性狭窄性肠炎(CMUSE),这是一种罕见疾病,可能由PLA2G4A基因突变引起,其特征为小肠多处短段狭窄伴浅表溃疡,溃疡不超过黏膜下层。炎症性肠病(克罗恩病)、肠结核以及非甾体抗炎药继发的肠道溃疡是主要的鉴别诊断。总之,医生应将CMUSE纳入反复腹痛、缺铁性贫血、隐匿性肠道出血、水肿和蛋白丢失性肠病的鉴别诊断中。