维得利珠单抗治疗伴有直肠瘘和直肠前脓肿的克罗恩病：一例报告。
Vedolizumab in Crohn's disease with rectal fistulas and presacral abscess: A case report.
机构信息
School of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan.
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
出版信息
World J Gastroenterol. 2021 Feb 7;27(5):442-448. doi: 10.3748/wjg.v27.i5.442.
BACKGROUND
Fistula and intraabdominal fistula are common complications of Crohn's disease (CD), but complex rectal fistula with abscess formation is rare. Tumor necrosis factor antagonists combined with percutaneous drainage or surgical intervention is optimal treatment for fistulizing CD with intraabdominal abscess. There is no study show the efficacy of vedolizumab in such complicated condition.
CASE SUMMARY
A 47-year-old man has decompensated liver cirrhosis, child B. He suffered from abdominal pain, bloody diarrhea, fever, and body weight loss. CD with rectoprostatic fistula, rectopresacral fistula, pre-sacral abscess and cyto-megalovirus (CMV) infection were noted. He received antibiotics, anti-viral therapy, transverse colostomy and vedolizumab treatment. Six months later, he had deep remission and complete fistula tracts closure.
CONCLUSION
Early vedolizumab and stool diversion are effective and safe in treating CD with complex rectal fistula with abscess formation.
背景
瘘管和腹腔内瘘管是克罗恩病（CD）的常见并发症，但伴有脓肿形成的复杂直肠瘘管则较为罕见。对于伴有腹腔内脓肿的瘘管型 CD，肿瘤坏死因子拮抗剂联合经皮引流或手术干预是最佳治疗方法。目前尚无研究表明维得利珠单抗在这种复杂情况下的疗效。
病例总结
一名 47 岁男性患有代偿性肝硬化，Child B 级。他出现腹痛、血性腹泻、发热和体重减轻。经检查发现患有直肠前列腺瘘、直肠骶前瘘、骶前脓肿和巨细胞病毒（CMV）感染。他接受了抗生素、抗病毒治疗、横结肠造口术和维得利珠单抗治疗。6 个月后，他的病情深度缓解，瘘管完全闭合。
结论
早期使用维得利珠单抗和粪便转流术治疗伴有脓肿形成的复杂直肠瘘管是有效且安全的。
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