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肠炎诱发的吻合口破裂:一例报告及文献综述

Enteritis Induced Anastomotic Rupture: A Case Report and Literature Review.

作者信息

Velez David R, Ahmeti Mentor

机构信息

School of Medicine & Health Sciences, Department of Surgery, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202, USA.

Sanford Medical Center, Fargo, ND, USA.

出版信息

Case Rep Surg. 2020 Jun 13;2020:9794823. doi: 10.1155/2020/9794823. eCollection 2020.

Abstract

. A 76-year-old male patient who suffered small bowel anastomotic dehiscence believed to be a complication provoked by enteritis. . The patient was a 76-year-old male who underwent small bowel resection with primary anastomosis for a small bowel obstruction. On postoperative day #7, he rapidly decompensated and upon return to the operating room was found to have complete anastomotic dehiscence with copious enteric spillage. The presentation appeared as if the staple line had burst open. Enteric contents confirmed the diagnosis of enteritis. Subsequent hospital course was complicated by ventilatory-dependent respiratory failure, hemodynamic instability, and persistent anemia secondary to gastric ulcer requiring endoscopic cauterization. After a prolonged hospital course, he eventually progressed and was transferred to a skilled nursing facility on hospital day #42. . causes inflammation and copious large volume secretions that would theoretically increase intraluminal pressures creating an internal tension. This tension along with other factors from the infection itself would likely be inhibitory of anastomotic healing. Although it is rare, enteritis is being reported with increasing frequency, and in the setting of recent small bowel anastomosis, it should be considered a possible risk factor for anastomotic leak.

摘要

一名76岁男性患者发生小肠吻合口裂开,据信这是由肠炎引发的一种并发症。该患者为76岁男性,因小肠梗阻接受了小肠切除并一期吻合手术。术后第7天,他病情迅速恶化,返回手术室时发现吻合口完全裂开,有大量肠内容物溢出。表现像是吻合钉线裂开。肠内容物证实了肠炎的诊断。随后的住院过程因依赖呼吸机的呼吸衰竭、血流动力学不稳定以及继发于胃溃疡需内镜烧灼治疗的持续性贫血而变得复杂。经过漫长的住院过程,他最终病情好转,并于住院第42天转至一家专业护理机构。肠炎会引发炎症和大量分泌,理论上会增加管腔内压力,产生内部张力。这种张力连同感染本身的其他因素可能会抑制吻合口愈合。虽然肠炎很罕见,但报告的频率在增加,在近期小肠吻合的情况下,应将其视为吻合口漏的一个可能危险因素。

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本文引用的文献

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Clostridium difficile enteritis: a new role for an old foe.艰难梭菌肠炎:宿敌的新角色
Surgeon. 2014 Oct;12(5):256-62. doi: 10.1016/j.surge.2014.01.008. Epub 2014 Mar 4.
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