Crooks K K, Hensle T W, Heney N M, Waltman A, Irwin R J
Urology. 1978 Dec;12(6):689-93. doi: 10.1016/0090-4295(78)90433-8.
The clinical features and management of 3 patients who presented with the triad of massive hemorrhage from the ileal conduit, portal hypertension due to liver disease, and portosystemic varices related to the conduits are described. One patient, a class C cirrhotic, was treated conservatively and died of blood loss and hepatic coma. Two patients were managed with splenorenal shunts initially, followed by creation of colon conduits, and are currently doing well. Surgical approximation of areas draining in the portal and systemic circulation with subsequent development or adhesion-related varices probably explains the predilection for involvement of the ileal conduit and may explain the presence of varices in mild to moderate portal hypertension before other signs of hepatic decompensation are evident. Superior mesenteric angiography with special attention directed at the venous phase is necessary to document this entity.
描述了3例出现回肠造口大量出血、肝病所致门静脉高压以及与造口相关的门体分流性静脉曲张三联征患者的临床特征及治疗情况。1例C级肝硬化患者接受了保守治疗，死于失血和肝昏迷。2例患者最初接受脾肾分流术治疗，随后进行结肠造口术，目前情况良好。门静脉和体循环引流区域的手术接近以及随后出现或与粘连相关的静脉曲张，可能解释了回肠造口受累的倾向，也可能解释了在肝失代偿的其他体征明显之前，轻度至中度门静脉高压时静脉曲张的存在。有必要进行肠系膜上动脉造影，并特别关注静脉期，以记录这一情况。
