TuŢă Liliana Ana, Boşoteanu Mădălina, Dumitru Eugen, Deacu Mariana
Department of Internal Medicine, Department of Nephrology, Faculty of Medicine, "Ovidius" University of Constanta, Emergency County Hospital, Constanta, Romania;
Rom J Morphol Embryol. 2017;58(1):249-253.
Diverticular disease is frequent amongst the elderly and immunosuppressed patients. It mainly presents as sigmoid diverticulitis, but severe complications, like bleedings, infections and colon perforation may occur, frequently due to immunosuppressive therapy. Moreover, antibiotherapy and hemostatics may not efficiently control evolution in such cases. Early diagnose and adequate treatment of colonic diverticulosis complicated with lower gastrointestinal bleeding and diverticulitis in immunocompromised patients. We report a 55-year-old patient who underwent de novo renal transplantation one year ago and recently developed a severe diverticular bleeding complicated by hemorrhagic shock. Colonoscopic examination revealed diverticular disease with diverticulitis and severe, diffuse bleeding, mainly in the descending colon. Due to his immunocompromised status and unfavorable evolution under hemostatics, recombinant coagulation factor VIIa (rFVIIa) was given to avoid surgery. The bleeding stopped after two doses of rFVIIa. Unfortunately, after three weeks, lower quadrant pain, tenderness, abdominal distention, and fever occurred, in spite of immunosuppressive drug changing and adequate conservative therapy. Abdominal computed tomography (CT) scan revealed complicated diverticulitis, so patient underwent surgery, with partial colectomy, followed by total recovery. In conclusion, diverticulosis coli complicated with lower gastrointestinal bleeding and diverticulitis in immunocompromised patients was for us a challenging diagnosis, as well as a therapeutic issue. Treatment options, usually based on our local resources and expertise, considered conservatory therapy as the first choice, keeping surgical maneuvers just as a rescue solution.
憩室病在老年人和免疫抑制患者中很常见。它主要表现为乙状结肠憩室炎，但可能会出现严重并发症，如出血、感染和结肠穿孔，这通常是由于免疫抑制治疗所致。此外，在这种情况下，抗生素治疗和止血药可能无法有效控制病情发展。免疫功能低下患者合并下消化道出血和憩室炎的结肠憩室病的早期诊断和适当治疗。我们报告一名55岁的患者，他一年前接受了首次肾移植，最近出现了严重的憩室出血并伴有失血性休克。结肠镜检查显示憩室病合并憩室炎以及严重的弥漫性出血，主要位于降结肠。由于他的免疫功能低下状态以及在止血药治疗下病情进展不利，给予重组凝血因子VIIa（rFVIIa）以避免手术。两剂rFVIIa后出血停止。不幸的是，三周后，尽管更换了免疫抑制药物并进行了充分的保守治疗，但患者仍出现了下腹部疼痛、压痛、腹胀和发热。腹部计算机断层扫描（CT）显示为复杂性憩室炎，因此患者接受了手术，行部分结肠切除术，随后完全康复。总之，免疫功能低下患者合并下消化道出血和憩室炎的结肠憩室病对我们来说是一个具有挑战性的诊断和治疗问题。治疗方案通常基于我们当地的资源和专业知识，将保守治疗作为首选，仅将手术作为一种挽救措施。
