Bosmans L, Storms P, Gruwez J A
Dienst Algemene Heelkunde, Katholieke Universiteit Leuven, UZ Gasthuisberg, Leuven.
Acta Chir Belg. 1993 Jan-Feb;93(1):25-7.
Occult intestinal bleeding was diagnosed in a patient who underwent a distal small bowel resection. The resection was required for small bowel obstruction. She developed iron deficiency anemia four years later. Clinically she presented with melena. Colonoscopy, gastroscopy were unsuccessful in making the diagnosis. But a 99 mass Technetium (99m Tc) Labeled Red Blood Cell (RBC) scintigraphy, established the bleeding site in the gastrointestinal tract. Laparotomy identified an ulcerative lesion at the surgical side-to-side anastomosis. Histology demonstrated focal ulceration with chronic inflammation but did not show crypt abscesses, or granulomata. Medical therapy, including iron and Histamine-antagonists were ineffective. She was treated with resection of the anastomosis. Gastrointestinal bleeding due to anastomotic ulceration appears to be a late complication of small bowel resection with side-to-side anastomosis.
一名接受远端小肠切除术的患者被诊断为隐匿性肠道出血。该切除术是因小肠梗阻而进行的。四年后她出现了缺铁性贫血。临床上她表现为黑便。结肠镜检查和胃镜检查未能做出诊断。但一次99锝（99m Tc）标记红细胞（RBC）闪烁扫描确定了胃肠道的出血部位。剖腹探查在手术侧侧吻合处发现了一个溃疡性病变。组织学显示局灶性溃疡伴慢性炎症，但未显示隐窝脓肿或肉芽肿。包括铁剂和组胺拮抗剂在内的药物治疗无效。她接受了吻合口切除术。吻合口溃疡导致的胃肠道出血似乎是侧侧吻合小肠切除术后的一种晚期并发症。
