Cunningham Georgina, Cameron Georgina, De Cruz Peter
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia. Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Austin Academic Center, Melbourne, Victoria, Australia.
BMJ Case Rep. 2014 Sep 26;2014:bcr2014206244. doi: 10.1136/bcr-2014-206244.
Hepatic portal venous gas (HPVG) is a rare finding that has only been reported previously among 25 patients with Crohn's disease in the English literature. We present a case of a 27-year-old woman with Crohn's disease who presented with fever, abdominal pain and per rectal bleeding and was found to have HPVG at the time of presentation most likely due to an enterovenous fistula. She was managed with intravenous antibiotics, corticosteroids and infliximab and subsequently made a full recovery. HPVG is most likely a manifestation of penetrating Crohn's disease, is overall associated with a low mortality rate and can be managed conservatively in the majority of cases associated with Crohn's disease. Although surgery has been suggested for cases of enterovenous fistulae in the past, this is the first case to suggest that use of antitumour necrosis factor therapy may arrest associated gastrointestinal bleeding and avoid the need for surgery.
肝门静脉积气（HPVG）是一种罕见的发现，此前英文文献中仅报道过25例克罗恩病患者出现这种情况。我们报告一例27岁克罗恩病女性患者，她出现发热、腹痛和直肠出血，就诊时发现有HPVG，最可能原因是肠静脉瘘。她接受了静脉抗生素、皮质类固醇和英夫利昔单抗治疗，随后完全康复。HPVG很可能是穿透性克罗恩病的一种表现，总体死亡率较低，在大多数与克罗恩病相关的病例中可进行保守治疗。尽管过去曾有人建议对肠静脉瘘病例进行手术，但这是首例表明使用抗肿瘤坏死因子疗法可能止住相关胃肠道出血并避免手术的病例。
