Sanchez E, Soravia C, Saraga E P, Magnenat G, Rostan O
Service de chirurgie, Hôpital de zone, Payerne, Université de Lausanne.
Helv Chir Acta. 1993 Sep;60(1-2):65-70.
This case illustrates the difficulty of diagnosing a colonic stenosis of ischemic origin. A 70-year-old lady presents with abdominal pain, fever and melaena. Lc are 15.2, ESR 39 mm, CEA 2.7 ng/ml. A barium enema shows a stenosis of the transverse colon that is suspicious of neoplasia. At time of operation, an induration of the transverse colon is found with edema of the corresponding mesocolon but no tumour is palpated. A resection of this area is performed and an end to end anastomosis performed. Pathology shows an ischemic colitis secondary to a lymphocytic thrombotic venulitis. The patient is discharged home one month postoperatively. 4 weeks later she is readmitted with the same symptoms. A gastrograffin enema shows a similar stenosis in the transverse colon including the anastomosis. The diagnosis is made of a recurrent ischemic stenosis. The patient improves over a 10-day period of conservative treatment (anticoagulation, TPN, steroids). A control barium enema shows a near resolution of the stenosis. The majority of ischemic colitis are of arterial origin nevertheless ischemic colitis of venous origin exists. The factor causing venous ischemia are not known. It is though thought to be associated with hypersensitivity vasculitis of drug origin. Its initial diagnosis versus neoplasia is difficult but once made there is a good response to a conservative treatment.
本病例说明了诊断缺血性起源的结肠狭窄的困难。一位70岁女性出现腹痛、发热和黑便。白细胞计数为15.2，红细胞沉降率为39mm，癌胚抗原为2.7ng/ml。钡剂灌肠显示横结肠狭窄，怀疑为肿瘤。手术时，发现横结肠变硬，相应的结肠系膜有水肿，但未触及肿瘤。对该区域进行了切除并进行了端端吻合。病理显示继发于淋巴细胞性血栓性静脉炎的缺血性结肠炎。患者术后1个月出院。4周后，她因相同症状再次入院。泛影葡胺灌肠显示横结肠包括吻合口处有类似狭窄。诊断为复发性缺血性狭窄。患者在10天的保守治疗（抗凝、全胃肠外营养、类固醇）期间病情好转。对照钡剂灌肠显示狭窄几乎消失。大多数缺血性结肠炎是动脉源性的，不过静脉源性的缺血性结肠炎也存在。导致静脉缺血的因素尚不清楚。据认为它与药物源性的超敏性血管炎有关。其与肿瘤的初步诊断很困难，但一旦确诊，对保守治疗反应良好。
