Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, Netherlands
Department of Surgery, Isala Hospital, Zwolle, Netherlands.
BMJ Case Rep. 2024 Aug 19;17(8):e261081. doi: 10.1136/bcr-2024-261081.
A man in his 60s presented to our emergency department with severe peripheral pitting oedema, weight gain, dyspnoea and diarrhoea. Blood tests showed a hypoalbuminaemia of 15 g/L. A suspicion of protein-losing enteropathy arose after the exclusion of albuminuria, cardiac failure, protein deficiency and liver cirrhosis. An abdominal CT scan revealed a wall thickening of the colon, and a subsequent colonoscopy identified multiple large obstructive polyps in the ascending colon. The patient underwent a right hemicolectomy which revealed the presence of tubulovillous polyps and a pT2N0 colon carcinoma. Following surgery, the patient experienced clinical improvement with normalisation of serum albumin and resolution of the oedema.Protein-losing enteropathy should be considered an underlying syndrome in patients with peripheral oedema and hypoalbuminaemia in the absence of cardiac failure, proteinuria, malnutrition and hepatic disease. This diagnostic process requires a multidisciplinary approach. For adequate treatment, the primary cause of protein-losing enteropathy needs to be investigated.
一位 60 多岁的男性因严重外周凹陷性水肿、体重增加、呼吸困难和腹泻到我院急诊科就诊。血液检查显示白蛋白 15g/L。在排除了蛋白尿、心力衰竭、蛋白质缺乏和肝硬化后，怀疑为蛋白丢失性肠病。腹部 CT 扫描显示结肠壁增厚，随后的结肠镜检查发现升结肠有多个大的阻塞性息肉。患者接受了右半结肠切除术，术中发现存在管状绒毛状息肉和 T2N0 期结肠癌。手术后，患者的临床症状得到改善，血清白蛋白恢复正常，水肿消退。蛋白丢失性肠病应被视为外周水肿和低白蛋白血症而无心力衰竭、蛋白尿、营养不良和肝病的患者的潜在综合征。该诊断过程需要多学科方法。为了进行充分的治疗，需要调查蛋白丢失性肠病的主要病因。
