Kantamaneni Vamsi Krishna, Gurram Krishna C, Kulkarni Abhijit
Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2017 May 22;2017:bcr-2017-219957. doi: 10.1136/bcr-2017-219957.
Extraintestinal is rare. A 74-year-old man with a history of ulcerative colitis presented after a fall. Trauma work-up showed liver cirrhosis. Two days later he developed abdominal pain, distension, diarrhoea and leucocytosis. Stool tested positive for CT abdomen showed pancolitis with toxic megacolon. Total abdominal colectomy and ileostomy with a rectal stump was performed. He was discharged, but was readmitted with sepsis. CT abdomen showed a 10.4×7.2 cm fluid collection in the pelvis. stool was negative. CT-guided abscess drainage grew Barium enema was negative for communication from the rectal stump to the abscess. The patient was treated with metronidazole for 2 weeks. In summary, extraintestinal can develop from recent antibiotics use, gastrointestinal surgery and microperforations from toxic megacolon. We recommend abscess drainage, concomitant treatment with metronidazole and or vancomycin, and reimaging of abscess location 2-4 weeks after cessation of antibiotics.
肠外并发症较为罕见。一名有溃疡性结肠炎病史的74岁男性在跌倒后就诊。创伤检查显示肝硬化。两天后，他出现腹痛、腹胀、腹泻和白细胞增多。粪便检测呈阳性，腹部CT显示全结肠炎伴中毒性巨结肠。进行了全腹结肠切除术及带直肠残端的回肠造口术。他出院了，但因脓毒症再次入院。腹部CT显示盆腔有一个10.4×7.2厘米的液性包块。粪便检测为阴性。CT引导下脓肿引流培养出……钡灌肠显示直肠残端与脓肿之间无相通。患者接受甲硝唑治疗2周。总之，肠外并发症可由近期使用抗生素、胃肠道手术以及中毒性巨结肠的微小穿孔引起。我们建议进行脓肿引流，同时使用甲硝唑和/或万古霉素治疗，并在停用抗生素2 - 4周后对脓肿位置进行再次成像。
