Bender J S, Ratner L E, Magnuson T H, Zenilman M E
Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA.
Surgery. 1995 May;117(5):494-7. doi: 10.1016/s0039-6060(05)80247-8.
The cause and frequency of the acute abdomen in patients undergoing hemodialysis are not well reported. Previous studies associate bowel infarction with hemodialysis, but dialysis generally is not implicated as a risk factor for mesenteric ischemia.
The records of 567 patients undergoing long-term hemodialysis during the period from July 1988 to June 1993 were retrospectively reviewed.
Twelve patients (2.1% of the hemodialysis population) were admitted with acute abdominal pain or sepsis. They were demographically no different than their counterparts who did not have an acute abdomen. The final diagnoses were bowel infarction in 11 patients and acute pancreatitis in one. Principal areas of involvement were equally divided between large and small intestine and were due to nonocclusive mesenteric ischemia in all cases. Six patients had an occluded hemodialysis fistula on admission, suggesting hypotension and/or hypovolemia as a possible etiologic factor. Overall, mortality and major morbidity rates were 50% and 25%, respectively.
An acute abdomen is a relatively uncommon problem in the hemodialysis population but is associated with a high mortality. Mesenteric infarction is the most common cause and should be the presumptive diagnosis until proven otherwise.
血液透析患者急腹症的病因及发生率尚未得到充分报道。既往研究将肠梗死与血液透析相关联，但透析一般不被认为是肠系膜缺血的危险因素。
回顾性分析1988年7月至1993年6月期间567例长期血液透析患者的病历。
12例患者（占血液透析人群的2.1%）因急性腹痛或脓毒症入院。他们在人口统计学特征上与无急腹症的患者没有差异。最终诊断为11例肠梗死和1例急性胰腺炎。主要受累部位在大肠和小肠之间平均分布，所有病例均由非闭塞性肠系膜缺血引起。6例患者入院时存在血液透析瘘管闭塞，提示低血压和/或血容量不足可能是病因。总体而言，死亡率和主要发病率分别为50%和25%。
急腹症在血液透析人群中是一个相对少见的问题，但与高死亡率相关。肠系膜梗死是最常见的原因，在未得到其他证实之前应作为初步诊断。
