Brandt L J, Katz H J, Wolf E L, Mitsudo S, Boley S J
Gastroenterology. 1985 May;88(5 Pt 1):1137-42. doi: 10.1016/s0016-5085(85)80072-x.
Nine cases of colonic ischemia are presented in which an initial diagnosis of carcinoma was made from roentgenographic, endoscopic, or intraoperative appearance of the lesion. The clinical features were insufficient to differentiate colonic ischemia from carcinoma. In 7 patients a barium enema was interpreted as, or consistent with, carcinoma. In 3 of these patients colonoscopy also suggested malignancy. In 2 patients, endoscopy suggested a neoplasm but no barium enema was performed. Endoscopic biopsies when performed were negative for malignancy. Three patients were considered to have cancer from the gross appearance of the lesion at laparotomy. Routine use of both barium enema and colonoscopy in patients with suspected colonic neoplasms will usually identify the ischemic nature of lesions incorrectly diagnosed by one technique or the other. In the uncommon patient in whom both studies suggest a neoplasm, but biopsy specimens are negative for tumor, repeat studies 7-10 days later may identify the evolving nature of ischemic lesions and obviate the need for surgery. When no changes are seen, prompt laparotomy is indicated.
本文报告9例结肠缺血病例，这些病例最初根据病变的X线、内镜或术中表现诊断为癌。临床特征不足以区分结肠缺血和癌。7例患者的钡剂灌肠检查被解读为癌或与癌相符。其中3例患者的结肠镜检查也提示恶性肿瘤。2例患者内镜检查提示有肿瘤，但未进行钡剂灌肠检查。进行内镜活检时，结果均为恶性肿瘤阴性。3例患者因剖腹手术时病变的大体外观被认为患有癌症。对于疑似结肠肿瘤的患者，常规同时使用钡剂灌肠和结肠镜检查通常会发现被其中一种检查错误诊断的病变的缺血性质。在两种检查均提示肿瘤但活检标本为肿瘤阴性的罕见患者中，7 - 10天后重复检查可能会发现缺血性病变的演变性质，从而避免手术。如果未见变化，则应立即进行剖腹手术。
