Iwasaki Hiroaki, Jiang Shi-Xu
Department of Internal Medicine, Toshiba Rinkan Hospital, Sagamihara 252-0385, Japan.
Department of Pathology, Toshiba Rinkan Hospital, Sagamihara 252-0385, Japan.
Oxf Med Case Reports. 2022 Feb 19;2022(2):omac002. doi: 10.1093/omcr/omac002. eCollection 2022 Feb.
Diagnosis of an acute abdomen during an episode of diabetic ketoacidosis (DKA) is crucial for providing appropriate treatments and obtaining favourable outcomes, but may be difficult due to its considerable overlap with multiple intra-abdominal diseases in terms of clinical course and laboratory findings. In this study, we presented a case showing signs of an acute abdomen with sharp rises in serum pancreatic biochemical markers during the treatment of DKA with pyelonephritis. Contrast-enhanced computed tomography (CT) was performed to confirm the onset of acute pancreatitis; however, pneumatosis intestinalis and poor enhancement of the rectal wall were detected, indicating the presence of rectal infarction. Hartmann's procedure was immediately performed, and histological examination of the resected specimen revealed gangrenous ischaemic colitis. The present case highlights DKA as a risk factor of ischaemic colitis and the role of contrast-enhanced CT in the differential diagnosis of an acute abdomen in hyperglycaemic crisis.
在糖尿病酮症酸中毒（DKA）发作期间诊断急腹症对于提供适当治疗并取得良好预后至关重要，但由于其在临床过程和实验室检查结果方面与多种腹腔内疾病有相当大的重叠，诊断可能会很困难。在本研究中，我们报告了1例在伴有肾盂肾炎的DKA治疗期间出现急腹症体征且血清胰腺生化标志物急剧升高的病例。进行了对比增强计算机断层扫描（CT）以确认急性胰腺炎的发作；然而，检测到肠壁积气和直肠壁强化不佳，提示存在直肠梗死。立即进行了哈特曼手术，切除标本的组织学检查显示为坏疽性缺血性结肠炎。本病例突出了DKA作为缺血性结肠炎的一个危险因素以及对比增强CT在高血糖危象时急腹症鉴别诊断中的作用。
