Kin Y, Hoshino K, Mizushima Y, Kato H, Yano S, Sakamoto T
Arerugi. 1989 Oct;38(10):1173-9.
We present here the case of a patient with allergic granulomatous angitis (AGA) who had two small intestine perforations in a short interval, and we reviewed 11 cases, including our own, of AGA with accompanying gastrointestinal perforations reported so far in Japan. Our case was a twenty-three year old man who had been treated with steroid hormone in an outpatient clinic. He re-entered our hospital complaining of severe abdominal pain. At first admission, there had been no evidence of parasite disease, and this time, we found severe duodenal erosion on upper gastrointestinal endoscopy. Abdominal angiography revealed stenotic and tapering changes probably due to angitis in both the superior and inferior mesenteric arteries. Steroid pulse therapy was not effective in reducing the severity of abdominal pain, but the administration of a large amount of PGE1 was very effective. In spite of the therapy, the patient had small intestine perforations on his 27th day in hospital and two months thereafter, and was operated on twice. The death rate in AGA patients with accompanying gastrointestinal perforations is relatively high in our country, and 2 out of 11 cases had recurrent perforations. Therefore, it is considered essential to pay great attention to abdominal manifestations in AGA patients.
我们在此报告一例患有过敏性肉芽肿性血管炎（AGA）的患者，该患者在短时间内出现了两处小肠穿孔，并且我们回顾了包括我们自己的病例在内的11例日本迄今报道的伴有胃肠道穿孔的AGA病例。我们的病例是一名23岁男性，曾在门诊接受类固醇激素治疗。他因严重腹痛再次入院。首次入院时，没有寄生虫病的证据，而这次，我们在上消化道内镜检查中发现了严重的十二指肠糜烂。腹部血管造影显示肠系膜上动脉和肠系膜下动脉可能由于血管炎而出现狭窄和逐渐变细的改变。类固醇脉冲疗法在减轻腹痛严重程度方面无效，但大量前列腺素E1的给药非常有效。尽管进行了治疗，患者在住院第27天和此后两个月出现了小肠穿孔，并接受了两次手术。在我国，伴有胃肠道穿孔的AGA患者死亡率相对较高，11例中有2例出现复发性穿孔。因此，认为对AGA患者的腹部表现给予高度关注至关重要。
