Schosheim Alexander, Tobin Michelle, Chawla Anupama
Department ofPediatric Gastroenterology , Stony Brook University Hospital , Stony Brook, NY 11794, United States.
World J Gastrointest Endosc. 2020 Nov 16;12(11):500-503. doi: 10.4253/wjge.v12.i11.500.
While sunburns are very common, especially in pediatrics, curling ulcers secondary to sunburns are a very rare entity that has not been noted in the literature in over fifty years. This case is the first addition to the literature since the originally documented case.
A previously healthy 17 year old male presents to the emergency room with lethargy, shortness of breath on exertion, dark stools and nausea. His fatigue started to become significantly worse four days prior to admission. Approximately two weeks prior to admission, the patient was on a beach vacation with his family at which time he suffered severe sunburns. He had developed crampy epigastric abdominal pain, which was followed by dark, loose stools. On exam, he is non-toxic appearing, but with pallor and peeling skin on his face and chest with epigastric tenderness. Infectious stool studies were all negative including . He denies use of any non-steroidal anti-inflammatory drugs and also denies alcohol or recreational drug use. While admitted he is found to be significantly anemic with his hemoglobin as low as 6.3 requiring two units of packed red blood cells. Endoscopy revealed several severe and deep ulcerations in the antrum and body of the stomach indicative of stress or curling ulcers.
While the incidence of stress ulcers is not known, it is most common with severe acute illness, most commonly presenting as upper gastrointestinal (GI) bleeding. It is essential to be aware of the risk of curling ulcers secondary to severe sunburns as patients with stress ulcer GI bleeding have increased morbidity and mortality compared to those who do not have GI bleed.
晒伤非常常见，尤其是在儿科，但晒伤继发的柯林溃疡是一种非常罕见的病症，五十多年来文献中均未提及。本病例是自最初记录的病例以来首次被记载于文献中。
一名既往健康的17岁男性因嗜睡、活动时气短、黑便和恶心就诊于急诊室。入院前四天，他的疲劳感开始明显加重。入院前约两周，患者与家人在海滩度假，期间遭受了严重晒伤。他出现了上腹部绞痛，随后排出黑色稀便。检查时，他看起来并无中毒迹象，但面色苍白，面部和胸部皮肤脱皮，上腹部有压痛。包括……在内的感染性粪便检查均为阴性。他否认使用任何非甾体类抗炎药，也否认饮酒或使用消遣性药物。入院时发现他严重贫血，血红蛋白低至6.3，需要输注两单位浓缩红细胞。内镜检查显示胃窦和胃体有多处严重且深的溃疡，提示为应激性或柯林溃疡。
虽然应激性溃疡的发病率尚不清楚，但在严重急性疾病中最为常见，最常见的表现为上消化道出血。必须意识到严重晒伤继发柯林溃疡的风险，因为与没有消化道出血的患者相比，应激性溃疡导致消化道出血的患者发病率和死亡率更高。
