Couper R T, Durie P R, Stafford S E, Filler R M, Marcon M A, Forstner G G
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Gastroenterol Nutr. 1989 Nov;9(4):454-60. doi: 10.1097/00005176-198911000-00011.
Four children who underwent extensive small-bowel resection in infancy developed recurrent iron deficiency anemia due to gastrointestinal bleeding between 4 and 12 years later. The initial resections were required for multiple ileal atresia (n = 2) and gastroschisis (n = 2). Three patients have had melena and one had persistently guaiac-positive stools. Three patients had protein-losing enteropathy, and in one there was persistent hypoalbuminemia. Colonoscopy identified circumferential ulcerative lesions at the surgical anastomosis (n = 2) and at laparotomy another patient had well-defined linear ulcers close to the surgical anastomosis. Histology demonstrated focal ulceration with chronic inflammation, but did not show granulomata, crypt abscesses, or malignancy. Multiple imaging procedures and gastroduodenoscopy failed to identify an alternative bleeding source. Medical therapy including iron, antacids, sucralfate, H2 antagonists, and cholestyramine was ineffective. Two patients have undergone anastomotic resection. One experienced symptomatic recurrence 4 months after surgery. Repeat colonoscopy found ulceration at the new anastomosis with similar histology. The other patient remains asymptomatic 7 months postsurgery. Recurrent gastrointestinal hemorrhage due to anastomotic ulceration, of unknown etiology, appears to be a late complication of small-bowel resection in infancy.
4名婴儿期接受广泛小肠切除术的儿童在4至12年后因胃肠道出血出现复发性缺铁性贫血。最初的切除术是由于多发回肠闭锁（n = 2）和腹裂（n = 2）。3例患者出现黑便，1例粪便潜血持续阳性。3例患者患有蛋白丢失性肠病，1例存在持续性低白蛋白血症。结肠镜检查发现手术吻合口处有环形溃疡性病变（n = 2），剖腹手术时另1例患者在手术吻合口附近有明确的线性溃疡。组织学显示局灶性溃疡伴慢性炎症，但未发现肉芽肿、隐窝脓肿或恶性肿瘤。多种影像学检查和胃十二指肠镜检查未能发现其他出血来源。包括铁剂、抗酸剂、硫糖铝、H2拮抗剂和考来烯胺在内的药物治疗无效。2例患者接受了吻合口切除术。1例患者术后4个月出现症状复发。重复结肠镜检查发现新吻合口处有溃疡，组织学相似。另1例患者术后7个月无症状。病因不明的吻合口溃疡导致的复发性胃肠道出血似乎是婴儿期小肠切除术后的一种晚期并发症。
