Takesue Y, Yokoyama T, Kodama T, Murakami Y, Imamura Y, Sasaki S, Akagi S, Matsuura Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Surg Today. 1997;27(9):858-62. doi: 10.1007/BF02385279.
A 29-year-old woman was hospitalized with a 1-month history of postprandial epigastric pain, nausea, and vomiting. An upper gastrointestinal tract X-ray series showed a marked narrowing of the pyloric region. A histological examination of duodenal mucosal biopsy samples showed granulomatous inflammation, and thus a diagnosis of intrinsic duodenal Crohn's disease was made. A second upper gastrointestinal tract X-ray revealed a persistent gastric outlet obstruction. At laparotomy, the duodenal wall was found to be thickened over a distance measuring 3.5 cm in length from the pyloric ring. A longitudinal incision was made over the entire length, up to 5.5 cm beyond the pyloric ring on either side, while Finney-type anastomosis was also performed. A postoperative upper gastrointestinal tract X-ray showed an improvement in the gastroduodenal passage. Enteral nutrition therapy was provided postoperatively. Omeprazole was administered at a dose of 20 mg/day for 2 months. The patient currently remains on maintenance therapy with famotidine at 20 mg/day and is clinically doing well.
一名29岁女性因餐后上腹部疼痛、恶心和呕吐1个月入院。上消化道X线系列检查显示幽门区明显狭窄。十二指肠黏膜活检样本的组织学检查显示肉芽肿性炎症，因此诊断为原发性十二指肠克罗恩病。第二次上消化道X线检查显示持续性胃出口梗阻。剖腹手术时，发现十二指肠壁在距幽门环3.5厘米的长度范围内增厚。在整个长度上做了纵向切口，两侧超出幽门环5.5厘米，同时还进行了芬尼式吻合术。术后上消化道X线检查显示胃十二指肠通道有所改善。术后给予肠内营养治疗。奥美拉唑以20毫克/天的剂量给药2个月。患者目前继续接受法莫替丁20毫克/天的维持治疗，临床情况良好。
