Mergener K, Weinerth J L, Baillie J
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Gastroenterol. 1997 Dec;92(12):2289-91.
A 53-yr-old woman presented with a 2-yr history of recurrent episodes of severe abdominal pain and nausea. Multiple investigations by a general surgeon, a urologist, and a gastroenterologist failed to identify the cause. She was referred to our Biliary Service for ERCP and sphincter of Oddi manometry. However, a detailed history was inconsistent with biliary pain, and the patient, having discussed the risks and benefits, elected not to proceed with ERCP. The patient was asked to come to the hospital during an acute attack of her pain for assessment. When this was done, transabdominal ultrasound revealed right hydronephrosis; intravenous urography showed obstruction at the level of the ureteropelvic junction, consistent with the presence of an aberrant artery. The syndrome of episodic abdominal pain and hydronephrosis caused by extrinsic pressure from such an artery is known as Dietl's crisis. In our patient, the diagnosis was confirmed at surgery, when the ureteric obstruction was dealt with by pyeloplasty. She made an uneventful recovery and remains asymptomatic 12 months later. The keys to diagnosing Dietl's crisis are awareness of the entity, taking a detailed pain history, and timely cross-sectional abdominal imaging during an attack.
一名53岁女性，有2年反复出现严重腹痛和恶心发作的病史。普通外科医生、泌尿科医生和胃肠病学家进行的多项检查均未查明病因。她被转诊至我们的胆道服务部门进行内镜逆行胰胆管造影（ERCP）和Oddi括约肌测压。然而，详细病史与胆绞痛不符，且患者在讨论了风险和益处后，选择不进行ERCP。要求患者在疼痛急性发作时来医院进行评估。检查时，经腹超声显示右肾积水；静脉肾盂造影显示输尿管肾盂交界处梗阻，与存在异常动脉相符。由这种动脉的外在压迫引起的发作性腹痛和肾积水综合征称为Dietl危象。在我们的患者中，手术时确诊了该病，当时通过肾盂成形术处理了输尿管梗阻。她恢复顺利，12个月后仍无症状。诊断Dietl危象的关键是认识到该疾病、详细询问疼痛病史以及在发作期间及时进行腹部横断面成像检查。
