Maguire T M, Wensel R H, Malcolm N, Jewell L, Thomson A B
J Clin Gastroenterol. 1985 Jun;7(3):249-50. doi: 10.1097/00004836-198506000-00012.
A 65-year-old man presented with massive lower gastrointestinal tract hemorrhage. Minimal changes were noted on sigmoidoscopy, no bleeding lesions were identified on arteriography or red blood cell scan, and barium enema examination demonstrated only diverticular disease and minimal cecal deformity, interpreted as secondary to a recent appendectomy. Colonoscopy demonstrated multiple deep cecal ulcers. These were presumed to be due to an infectious etiology, since the stools were culture-positive for Salmonella typhimurium. The hemorrhage stopped within 24 hours of treatment with Ampicillin, Flagyl, and Gentamicin. The patient has remained well over a 12-month follow-up period. Repeat colonoscopy demonstrated healing of the cecal ulcers and there was also clearing of the Salmonella from the stools. This case report serves to remind us of the different methods used to diagnose lower gastrointestinal tract hemorrhage, and the importance of considering infectious causes of colitis.
一名65岁男性出现大量下消化道出血。乙状结肠镜检查发现轻微变化，动脉造影或红细胞扫描未发现出血性病变，钡剂灌肠检查仅显示憩室病和轻微的盲肠畸形，推测为近期阑尾切除术后的继发性改变。结肠镜检查发现多个深部盲肠溃疡。由于粪便中鼠伤寒沙门氏菌培养呈阳性，推测这些溃疡是由感染性病因引起的。使用氨苄青霉素、甲硝唑和庆大霉素治疗24小时内出血停止。在12个月的随访期内，患者情况良好。重复结肠镜检查显示盲肠溃疡愈合，粪便中的沙门氏菌也已清除。本病例报告旨在提醒我们诊断下消化道出血的不同方法，以及考虑结肠炎感染性病因的重要性。
