Mishra Swastik Sourav, Mishra Tushar Subhadarshan, Mitra Suvradeep, Kumar Pankaj
Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
AIIMS Bhubaneswar, Room No. 403, Academic building, AIIMS Road, Patrapada, Bhubaneswar, Sijua, 751019, India.
J Med Case Rep. 2021 Apr 23;15(1):215. doi: 10.1186/s13256-021-02719-3.
Thromboangiitis obliterans or Buerger's disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented.
Our Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery.
Acute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger's disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.
血栓闭塞性脉管炎或伯格氏病是年轻男性吸烟者的一种外周血管疾病形式。肠道受累仅发生在约2%的病例中，此时可能因肠系膜缺血而表现为急腹症。该病症不常见，使其成为较少被怀疑的鉴别诊断，导致适当治疗延迟，从而增加发病或死亡几率。已知戒烟可使疾病进展包括内脏受累停滞，但情况并非总是如此，正如所呈现的病例那样。
我们的印度印度教男性患者，是一名已知的吸烟者，出现弥漫性腹痛并伴有呕吐和腹泻。他4年前有过右脚截肢史。就诊时他有腹胀，伴有弥漫性压痛和肌卫。初次探查时发现一条附着于阑尾尖端的网膜束带以及近端肠袢扩张，为此进行了网膜束带松解术及阑尾切除术。术后第6天他出现肠皮肤瘘，为此不得不再次探查，发现多处空肠穿孔。进行了节段性空肠切除、Roux-en-Y胃空肠吻合术及远端回肠造口术，同时做了空肠造口喂养术。然而患者伤口再次出现粪便样排出物，为此进行了第三次探查。胃空肠吻合口和空肠造口喂养部位有渗漏，均进行了一期修复。患者发生败血症，进而发展为难治性感染性休克，最终在首次手术的术后第23天死亡。
一名慢性吸烟者且有非创伤性原因导致的肢体某部分截肢既往史的年轻男性出现急腹症，应怀疑肠道伯格氏病。尽管这是一种进行性疾病，且肠道症状出现时病情已进展，但早期发现可能会有一些挽救机会并降低发病率和死亡率。
