Yokoyama T, Masaki T, Ono M, Shinozaki M, Muto T
First Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Surg Today. 1998;28(11):1179-81. doi: 10.1007/s005950050309.
We report herein the cases of two patients with ulcerative colitis complicated by massive hemorrhage who were successfully treated by per anal suturing of a bleeding ulcer. A 40-year-old woman and a 22-year-old man had suffered from extensive colitis for 8 and 2 years, respectively, and both followed a similar clinical course. They were admitted under emergency conditions and, despite treatment with intravenous high-dose prednisolone and thereafter with intraarterial injections of prednisolone, suffered several attacks of massive hemorrhage with hypovolemic shock. Emergency subtotal colectomy with ileostomy and rectal mucous fistula were performed, but recurrent massive hemorrhage occurred during the early postoperative period. Bleeding from a discrete ulcer in the rectum was subsequently located, and both patients underwent per anal suturing of the ulcer. No recurrent bleeding occurred thereafter, and an ileoanal anastomosis was performed several months later. Massive hemorrhage is a rare complication of ulcerative colitis which is most often resolved by subtotal colectomy without proctectomy. Although bleeding associated with ulcerative colitis usually occurs diffusely, these case reports serve to demonstrate that massive bleeding can also result from a discrete ulcer. We advocate that this condition be treated by an endoscopic or local hemostatic procedure.
我们在此报告两例溃疡性结肠炎并发大出血患者的病例，他们通过经肛门缝合出血性溃疡成功治愈。一名40岁女性和一名22岁男性分别患有广泛性结肠炎8年和2年，两者临床病程相似。他们在紧急情况下入院，尽管接受了静脉高剂量泼尼松龙治疗，随后又接受了动脉内注射泼尼松龙治疗，但仍多次发生大出血并伴有低血容量性休克。进行了急诊次全结肠切除术加回肠造口术和直肠黏膜瘘，但术后早期仍反复发生大出血。随后发现是直肠一处孤立溃疡出血，两名患者均接受了经肛门溃疡缝合术。此后未再发生出血，数月后进行了回肠肛管吻合术。大出血是溃疡性结肠炎的一种罕见并发症，最常通过次全结肠切除术（不切除直肠）解决。虽然溃疡性结肠炎相关出血通常呈弥漫性发生，但这些病例报告表明，大出血也可能由孤立溃疡引起。我们主张通过内镜或局部止血程序治疗这种情况。
