Korzets Z, Ben-Chitrit S, Bernheim J
Department of Nephrology and Hypertension, Meir General Hospital, Kfar Saba, Israel.
Nephron. 1996;74(2):415-8. doi: 10.1159/000189345.
Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.
非闭塞性肠系膜梗死在透析患者中的诊断频率最近有所增加。尽管大多数报告涉及血液透析患者，但也有报告称这种情况发生在持续非卧床腹膜透析患者中。本报告描述了一名女性患者发生的此类病例，其终末期肾衰竭是由成人多囊肾病引起的。相关的易感因素包括体位性低氧血症、体位性低血压以及腹主动脉广泛的动脉粥样硬化改变。鉴于肠系膜缺血诊断的已知困难，我们患者的诊断也被延迟了。她最初被认为是因清洁灌肠引发了腹膜炎和/或结肠穿孔。直到腹部计算机断层扫描显示右半结肠有结肠积气时才做出正确诊断。剖腹探查发现升结肠和横结肠广泛坏死。进行了全结肠切除术和回直肠吻合术。患者在术后第17天死亡。该病例表明，对于持续非卧床腹膜透析的易感患者应考虑肠系膜梗死。腹膜炎的存在可能掩盖潜在病变并误导粗心的医生。
