Pateria Puraskar, Chong Andre
Corresponding author: Department of Gastroenterology and Hepatology, Service 4, CD09, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150,
Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150.
Diving Hyperb Med. 2018 Sep 30;48(3):194-196. doi: 10.28920/dhm48.3.194-196.
A 54-year-old male had undergone right hemicolectomy and ileo-colonic anastomosis for carcinoma-in-situ found at colonoscopy. Eighteen months later, he presented with a lower gastrointestinal bleed from an anastomotic ulcer, treated with resection of the anastomotic site and ileo-sigmoid anastomosis. In the ensuing 12 months, he had three episodes of haematochezia. Colonoscopy revealed a 12 mm anastomotic ulcer necessitating a further colonic resection and re-anastomosis. Two-years later, he presented with iron deficiency anaemia. He preferred expectant management and received ten iron-infusions over the subsequent four years. Thereafter, he developed painless haematochezia. Colonoscopy showed a 15 mm linear ulcer with mild ooze at the anastomosis. Histology was consistent with an ischaemic ulcer; there was no evidence of recurrence of carcinoma-in-situ. The ulcer remained refractory to endoscopic and medical treatment, as seen at three follow-up colonoscopies. Hyperbaric oxygen treatment (HBOT) was offered and he received 30 sessions over six weeks. Colonoscopy at HBOT completion revealed healing of the ulcer. The patient had no further overt bleeding and serum ferritin has continued to rise spontaneously over 12 months follow-up.
一名54岁男性因结肠镜检查发现原位癌接受了右半结肠切除术和回肠-结肠吻合术。18个月后，他因吻合口溃疡出现下消化道出血，接受了吻合口部位切除术和回肠-乙状结肠吻合术。在随后的12个月里，他出现了三次便血。结肠镜检查发现一个12毫米的吻合口溃疡，需要进一步进行结肠切除和重新吻合。两年后，他出现缺铁性贫血。他倾向于保守治疗，在随后的四年里接受了十次铁剂输注。此后，他出现无痛便血。结肠镜检查显示吻合口处有一个15毫米的线性溃疡，有轻度渗血。组织学检查结果与缺血性溃疡一致；没有原位癌复发的证据。如三次随访结肠镜检查所见，该溃疡对内镜治疗和药物治疗均无反应。于是为他提供了高压氧治疗（HBOT），他在六周内接受了30次治疗。高压氧治疗结束时的结肠镜检查显示溃疡已愈合。患者没有再出现明显出血，在12个月的随访中血清铁蛋白持续自发升高。
