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一例不明原因空肠毛细血管扩张症合并出血的病例报告。

A case report of unexplained jejunal telangiectasia complicated with bleeding.

作者信息

Zhang Wen-Jun, Huang You-Shan, Zhu Zheng-Ming, Luo Hong-Liang

机构信息

The Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, 343000, China.

The Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, 343000, China.

出版信息

Int J Surg Case Rep. 2020;67:219-222. doi: 10.1016/j.ijscr.2020.01.062. Epub 2020 Feb 6.

Abstract

INTRODUCTION

Small intestinal telangiectasia is a clinically rare disease, which is mainly characterized by gastrointestinal bleeding. There is a lack of specific and effective diagnostic methods in clinical practice due to its unknown etiology and difficult localization, it is often difficult to find the location of the lesion even through observation, touch, endoscope or intestinal incision.

CASE PRESENTATION

A 39-year-old female patient, who had black stool twice without obvious inducement 3 days ago, and came to our hospital for treatment and was hospitalized with gastrointestinal bleeding. the main manifestation of this patient was repeated black stool, sometimes dark red. Initially, we considered other diseases of the digestive tract (gastric ulcers, duodenal ulcers and intestinal tumors). However, no abnormalities were found by CT, gastroscopy and enteroscopy. Later, we considered that there was a greater possibility of intestinal vascular disease, and then blood clots was found in the upper and middle segment of the jejunum through capsule endoscopy, but no bleeding site was found. Therefore, we decided to open the abdomen for further intraoperative enteroscopy exploration, finally found the bleeding point, and then stopped the bleeding by suture. Later, through further follow-up, no rebleeding was found in the patient.

CONCLUSION

Jejunal telangiectasia with bleeding is a very rare intestinal vascular disease, which is difficult to identify and diagnose clinically. Therefore, the possibility of this disease should be considered in patients with negative results through some examinations such as gastroscopy, enteroscopy, gastrointestinal barium meal radiography, etc. In order to treat in time and prevent bleeding.

摘要

引言

小肠毛细血管扩张症是一种临床罕见疾病,主要特征为胃肠道出血。由于其病因不明且定位困难,临床实践中缺乏特异有效的诊断方法,即便通过观察、触诊、内镜检查或肠切开术,往往也难以找到病变部位。

病例介绍

一名39岁女性患者,3天前无明显诱因排黑便两次,遂来我院就诊并因胃肠道出血住院。该患者主要表现为反复排黑便,有时为暗红色。起初,我们考虑为其他消化道疾病(胃溃疡、十二指肠溃疡和肠道肿瘤)。然而,CT、胃镜和肠镜检查均未发现异常。后来,我们认为肠道血管疾病的可能性较大,随后通过胶囊内镜在空肠中上段发现血凝块,但未找到出血部位。因此,我们决定开腹进行术中肠镜进一步探查,最终找到出血点,然后通过缝合止血。之后,经过进一步随访,患者未再出现出血情况。

结论

出血性空肠毛细血管扩张症是一种极为罕见的肠道血管疾病,临床难以识别和诊断。因此,对于胃镜、肠镜、胃肠道钡餐造影等检查结果为阴性的患者,应考虑本病的可能性。以便及时治疗并预防出血。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/721e/7025968/0b787d752559/gr1.jpg

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