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缺血性肠炎所致回肠狭窄的临床特征及外科治疗:三例报告

Clinical characteristics and surgical management of ileal strictures caused by ischemic enteritis: a report of three cases.

作者信息

Kondo Yuya, Tsujinaka Shingo, Miura Tomoya, Kitamura Yoh, Sato Yoshihiro, Sawada Kentaro, Mitamura Atsushi, Nakano Toru, Katayose Yu, Shibata Chikashi

机构信息

Division of Gastroenterologic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino, Sendai, Miyagi 983-8536, Japan.

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino, Sendai, Miyagi 983-8536, Japan.

出版信息

J Surg Case Rep. 2025 Jun 3;2025(6):rjaf363. doi: 10.1093/jscr/rjaf363. eCollection 2025 Jun.

Abstract

Ischemic enteritis (IE) is characterized by blood flow insufficient to meet metabolic demands. The incidence of IE is increasing owing to the aging population and advancements in radiographic and endoscopic diagnostics. Many patients eventually require surgical management, indicating an irreversible and progressive pathology. Therefore, clear definitions, early diagnosis, and tailored treatments are crucial. Herein, we report three patients with ileal strictures caused by IE who were successfully treated with surgical resection. In all three cases, the stricture was segmental and located within 50 cm from the ileocecal valve, which is a characteristic radiological feature of IE. Histological analysis revealed segmental, circumferential ulcers with inflammatory-cell infiltration, and fibrosis, although the presentation may vary with the disease phase. Clinicians and surgeons should consider IE in patients with small bowel obstruction and segmental strictures without apparent acute ischemia, especially in older patients with severe comorbidities such as hypertension, diabetes, hyperlipidemia, or thromboembolic diseases.

摘要

缺血性肠炎(IE)的特征是血流不足以满足代谢需求。由于人口老龄化以及放射学和内镜诊断技术的进步,IE的发病率正在上升。许多患者最终需要手术治疗,这表明其病理过程是不可逆且进行性的。因此,明确的定义、早期诊断和个性化治疗至关重要。在此,我们报告三例由IE引起的回肠狭窄患者,他们通过手术切除成功治愈。在所有三例病例中,狭窄均为节段性,位于距回盲瓣50厘米以内,这是IE的一个特征性放射学表现。组织学分析显示节段性、环形溃疡伴炎症细胞浸润和纤维化,尽管其表现可能因疾病阶段而异。临床医生和外科医生在遇到小肠梗阻和节段性狭窄且无明显急性缺血的患者时,应考虑IE,尤其是患有高血压、糖尿病、高脂血症或血栓栓塞性疾病等严重合并症的老年患者。

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