缺血性肠病30例临床特点分析

目的探讨缺血性肠病的临床特点。方法回顾性分析襄阳市中心医院1998—2012年收治的30例缺血性肠病患者的临床特点。结果 30例中,内科保守治疗27例,手术治疗3例,全部治愈无死亡。从临床特点分析,夜间发病者占40%(12例),进食高脂肪食物者20%(6例),口服避孕药者10%(3例),有心脑血管病史者60%(18例),过度劳累者占13.3%(2例),所有患者均有腹痛及血便症状,实验室检查无特异性阳性结果,影像学检查仍为诊断缺血性肠病的主要手段,53.3%(16例)患者结肠镜下表现较为典型。结论具有典型腹痛,血便症状,特别是合并心脑血管病史,夜间发病及进食高脂肪食物者要高度怀疑缺血性肠病的诊断。     

缺血性结肠炎42例临床和内镜特点分析

目的 总结缺血性结肠炎临床与内镜下特点及临床疗效,探讨其诊断方法,防止误诊误治.方法 分析42例缺血性结肠炎患者的临床、内镜、病理特点及治疗等相关资料.结果 55岁以上中老年患者35例(83.3%),女性较易发生,男:女为1:1.8,伴有高血压、冠心病、高脂血症、糖尿病及便秘等基础疾病及诱因33例(78.6%).临床特点主要为突发性的腹部剧痛、腹泻和血便.内镜下表现为局限性肠黏膜充血水肿、糜烂、出血及溃疡.36例(85.7%)为一过型,经及时诊断和治疗后痊愈.结论 缺血性结肠炎患者预后良好的关键是及时的诊断和正确的治疗.     

探讨两种无创方法——肠道血管64排CT和结肠镜检查对急性缺血性肠病的诊断价值

目的 分析缺血性肠病的无创性诊断方法,并进行比较.方法 回顾性分析我院2007～ 2011年经临床证实的70例缺血性肠病患者的临床资料.结果 70例患者中,结肠镜检查结果提示缺血性肠病的有69例,64排CT检查结果提示缺血性肠病的有67例.两种方法诊断率均大于95％,且无统计学差异.结论 电子结肠镜和肠道血管64排C...     

缺血性肠病34例诊治分析

缺血性肠病是指结肠和（或）小肠因供血不足发生的缺血性肠道损害。本文对34例缺血性肠病患者的临床资料进行回顾性分析,现报告如下。     

房颤伴缺血性肠病患者血α-GST、CRP、D-二聚体相关性

目的分析房颤伴缺血性肠病患者血清α-GST、CRP、D-二聚体相关性,并探讨其在早期诊断中的作用。方法选取30例正常对照来自本院健康体检者,年龄50岁以上。入选者排除各类心血管疾病、糖尿病和肝肾疾病。30例单纯房颤患者,30例房颤伴缺血性肠病患者,均抽取静脉血,测定3组血清α-GST、CRP、D-二聚体,并分析其与缺血性肠病的关系。结果与正常对照组相比,单纯房颤患者组静脉血清CRP升高(P0.05),房颤伴缺血性肠病患者静脉血清CRP、α-GST、D-二聚体均升高(P0.05)。结论房颤是缺血性肠病危险因素,CRP、α-GST、D-二聚体可作为房颤伴缺血性肠病患者早期诊断标准之一。     

脾切除后暴发性感染并缺血性结肠炎的诊治体会

目的：提高对脾切除术后暴发性感染（OPSI）继发缺血性肠病的认识.方法：报道1例脾切除术后胰漏并暴发性感染,继发缺血性结肠炎患者的临床病历资料,结合文献分析诊治体会.结果：脾切除术后5d发生胰漏、继之肝功能损害、脓毒症,粒细胞缺乏症,反复血便,3次选择性腹腔动脉造影示结肠动脉分支破裂出血,肠镜发现结肠多发溃疡性病变,病理学见黏膜散在坏死,呈缺血性慢性炎症改变,经认真细致的诊断治疗获痊愈.结论：脾切除术后易发生凶险感染,多脏器功能损害,甚至粒细胞缺乏症、缺血性肠病,应早期识别,积极的抗生素治疗.     

老年人缺血性结肠炎的诊治

缺血性结肠炎是老年人常见的疾病,以腹痛和血便为主要症状.原因是由于结肠供血不足产生缺血性疼痛,造成肠黏膜的缺血性损伤,腹痛是其最主要的症状,常急性发作,绞痛样,疼痛持续伴阵发加重,伴随腹痛常有排便紧迫感,后出现腹泻和血便,血便量一般.因此对于出现急性腹痛、血便的老年患者要考虑缺血性结肠炎的诊断,并与结肠癌、直肠癌鉴别.     

心脏瓣膜置换术后合并缺血性肠病13例临床分析

目的分析心脏瓣膜置换术(mechanical heart valve replacement,MHVR)后并发缺血性肠病的病例资料,提高对该病的认识和临床诊治水平。方法回顾性分析13例缺血性肠病患者的临床资料、病史特点及各项辅助检查。结果 13例患者病史中均有MHVR,术后于不同时间出现腹痛、便血等临床症状。PT-INR比值为1.3~1.78,D-二聚体均升高,行结肠镜检查发现结肠节段性黏膜充血、糜烂、溃疡。经内科对症治疗后,12例恢复良好,1例行外科剖腹探查术,切除部分坏死小肠。结论对于曾行MHVR,术后低强度抗凝治疗的患者,突然出现腹痛、便血,应考虑缺血性肠病的可能,尽早进行相关检查,明确诊断,指导治疗。     

结肠镜检查对缺血性结肠炎的诊断价值

目的探讨缺血性结肠炎的临床、内镜特点及早期诊断方法。方法35例缺血性结肠炎患者在腹痛症状出现后72h内行全结肠内镜及病理检查,并于首次检查后2周～2个月内复查结肠镜,部分病例取病变黏膜活检,观察其内镜下表现及临床病理特点。结果35例患者临床主要表现为腹痛、血便及腹泻等,病变全部位于左半结肠。一过性炎症型33例,狭窄型2例;病理学表现无特异性。结论早期行结肠镜检是诊断缺血性结肠炎的主要方法。     

肉芽肿性血管炎致缺血性肠病1例

肉芽肿性血管炎(既往称为韦格纳肉芽肿)是一种以坏死性肉芽肿性血管炎为病理特征的多系统受累的自身免疫性疾病,主要累及上、下呼吸道和肾脏,甚少出现胃肠道表现.病变累及小肠或结肠时出现肠缺血和继发性腹膜炎症状,如腹痛、发热、腹泻、血便,但缺乏特异性,容易误诊.本文报告肉芽肿性血管炎致缺血性肠病1例,旨在提高临床医生对该病罕见临床表现的认识,早期诊断、早期治疗以延长患者生存期.     

12例缺血性肠病的临床分析

目的分析缺血性肠病（ischemic bowel disease,IBD）的临床特点、诊断及治疗。方法回顾性分析12例患者临床表现、合并症、腹部血管CT成像（CT angiography,CTA）或腹部血管彩超、电子结肠镜、治疗等。结果急性缺血性肠病3例,2例经手术治疗,1例发病72h内死亡。慢性缺血性肠病9例,8例经内科治疗好转,1例死亡。结论急性缺血性肠病多见于肠系膜上动脉闭塞,早诊断、早治疗较重要,出现肠坏死预后差。慢性性缺血性肠病多见于肠系膜上、下动脉狭窄及灌注不足,内科治疗疗效良好。肠道排空障碍可能是IBD的早期表现。     

小肠克罗恩病的特征分析

目的通过对小肠克罗恩病患者的临床特点分析,加深对小肠克罗恩病的认识,提高早期诊断水平,减少误诊率。方法对1992年1月～2006年12月期间在我院住院病历中符合克罗恩病的116例患者的临床特点进行回顾性分析。结果小肠克罗恩病24例（20．69％）,青壮年好发,首次确诊时间比其他类型克罗恩病患者更长。其临床主要表现为腹痛20例（83．33％）,便秘8例（33．3％）,腹泻6例（25％）,便血6例（25％）,消瘦14例（58．3％）,贫血8例（33．3％）,发热7例（29．2％）,手术18例（75％）。结论小肠克罗恩病临床表现多样化,诊断困难。小肠钡灌检查可作为小肠克罗恩病的有效筛查手段。     

Abdominal Tuberculosis May Masquerade Many Diseases

Background/Aim:

Intestinal tuberculosis needs to be considered in the differential diagnosis when patients with intestinal pathology are encountered. Tuberculosis can mimic other disease entities like, ischemic enteritis, inflammatory bowel diseases, malignancies, intussusception etc., clinically as well as morphologically in resected intestinal specimens. We aimed to study the various clinical presentations leading to intestinal resection, with identification of different etiological factors by histopathological examination; and to illustrate, discuss and describe the various histopathological features of the lesions in these resected intestinal specimens with clinicopathological correlation.

Materials and Methods:

We studied 100 cases of resected intestinal specimens received during September 2002 to December 2003. We totally encountered 22 request forms with clinical suspicion of ileoceocal tuberculosis.

Results:

Abdominal tenderness and mass in ileoceocal region were noted in all cases. In many instances, the cases were operated for acute/subacute intestinal obstruction. Clinical and intra-operative diagnoses of tubercular enteritis, in many instances, were finally diagnosed histopathologically as ischemic enteritis (nine cases), chronic nonspecific enteritis (four cases), adenocarcinoma of the caecum, Crohn’s disease, intussusception (each one case), and correctly as intestinal tuberculosis in only six cases.

Conclusion:

Tuberculosis can mimic various disease entities, clinically and sometimes morphologically. Vice versa is also true. An increased awareness of intestinal tuberculosis coupled with varied clinical presentations, nonspecific signs and symptoms, difficulties in diagnostic methods and need of early and specific treatment should improve the outcome for patients with this disease.     

Cytomegalovirus enteritis after autologous peripheral blood stem cell transplantation

A 61-year-old male with non-Hodgkin's lymphoma (peripheral T-cell lymphoma, unspecified, clinical stage IVb) received autologous peripheral blood stem cell transplantation (PBSCT) during first remission. He was seropositive for cytomegalovirus (CMV) prior to autologous PBSCT. His posttransplant clinical course was complicated by refractory CMV enteritis, which manifested persistent abdominal pain, diarrhea, and bloody stool. Generally, gastrointestinal CMV disease is relatively rare after autologous PBSCT. However, our case indicates that CMV infection must be considered as a differential diagnosis in cases of unexplained hemorrhagic enteritis following autologous PBSCT.     

Duodenal involvement with Crohn's disease: a spectrum of radiographic abnormality.

The clinical and radiographic features of 22 cases of duodenal Crohn's disease were analyzed. The presenting clinical findings in the majority suggested peptic disease rather than regional enteritis. There was no cases of isolated duodenal Crohn's disease but a spectrum of radiographic abnormalities was produced by duodenal involvement with Crohn's disease which simulated a variety of clinical entities. A radiographic examination of the small bowel or colon was useful to confirm a diagnosis of Crohn's disease when duodenal abnormalities were suggestive.     

Multiple small bowel ruptures due to ischemic enteritis： A case report

A rare case of multiple small bowel ruptures due to ischemic enteritis (ISE) is reported. The patient was admitted to the hospital with acute abdominal pain followed by bloody diarrhoeas. Preoperative colonoscopic findings were similar to those presented in Crohn's disease. Intraoperatively, ischemic lesions and multiple ruptures were localized at the jejunum and the proximal ileum. Histopathological examination of the resected bowel segment established the diagnosis of ISE. Although ISE is not common, concurred multiple ruptures of the small bowel is a rare but actual complication.     

Acute small bowel ischemia without transmural infarction

Two patients with atrial fibrillation had abrupt onset of abdominal pain and massive small bowel distension suggesting mesenterial artery embolism. One patient had dilation of the left atrium and ventricle, the other a mitral value prolapse syndrome with a dilated left atrium. Both patients were treated conservatively and gradually recovered. A small bowel series performed several weeks after the acute episode showed loss of normal mucosa and narrowing of a long segment of the small bowel. A control examination in one patient one year later, still revealed jejunal mucosal abnormalities and stenosis, features similar to those occurring in Crohn's disease. Our observations suggest that analogous to ischemic colitis, an entity of acute ischemic small bowel enteritis exists. Mesenteric ischemia apparently can induce a clinical syndrome of "regional enteritis". The radiologic features should not be confused with those of Crohn's disease.     

小肠常见炎症性溃疡性疾患35例的X线诊断

目的分析小肠常见炎症性溃疡性疾患的 X 线表现.方法 35例小肠炎症性溃疡性疾患,男20例,女15例.其中肠结核11例,Corhn 病13例,肠 Behcet 病7例,单纯性溃疡和缺血性肠炎各2例.33例有病理结果,2例经临床治疗证实.结果病变局限于回肠,肠结核11例中有9例,Corhn 病13例中有10例,肠 Behcet 病7例中有5例,单纯性溃疡2例中有l例,2例缺血性肠炎均在回肠.部分病例累及回盲部.35例均有溃疡,形态表现多种多样,但纵行溃疡和裂隙仅见于 Crohn 病.大而深的溃疡5例,3例为肠 Behcet 病.浅而不规则溃疡13例,10例见于肠结核.横行溃疡2例均见于肠结核.结论肠溃疡的形态、周围粘膜的变化和肠管变形等 X 线特征是各种疾患的诊断依据.强调正确的诊断决定于良好的 X 线检查技术和对形态变化的正确解释.     

Eosinophilic enteritis presenting as acute abdomen: US features of two cases.

Eosinophilic enteritis is a rare disease which may mimic acute abdominal emergency. Two sonographically documented cases are presented, which were subsequently proven at operation. Although the sonographic features of severe echolucent bowel wall thickening were not specific, combination with clinical and laboratory data may suggest the correct diagnosis.