抗生素相关性出血性肠炎的临床及内镜特点

目的 分析抗生素相关性出血性肠炎的临床特点、内镜表现和治疗预后。方法 对6例阿莫西林(羟氨苄青霉素)及其他青霉素衍生物治疗后发生的出血性肠炎患者的临床表现、实验室检查、内镜特点、治疗疗效及随访情况进行分析。结果 发病前1周内口服阿莫西林及其他青霉素衍生物史；急性起病，血便伴腹绞痛或腹部不适；实验室检查外周血白细胞总数增高(67％)；结肠镜检查，肠黏膜出血、糜烂，病变主要在右半结肠；病理组织学检查提示黏膜慢性炎症，间质出血；停用口服抗生素，静脉短程激素治疗及支持治疗；病情恢复快，无合并症发生。结论 对于便血患者应仔细询问服药史，尤其是有无服用阿莫西林及青霉素衍生物。明确服药史，早期全结肠镜检查是明确诊断的关键。     

缺血性结肠炎的临床及内镜特点

目的总结缺血性结肠炎的临床和内镜特点。方法收集分析我院2000年6月至2005年6月经结肠镜和病理确诊的20例缺血性结肠炎的临床和内镜特点。结果本病好发于50岁以上的中老年人（75％），男女差别不大，多数伴有动脉硬化的基础疾病（80％）．临床主要表现为腹痛、便血等，内镜表现主要为黏膜高度充血水肿、出血、糜烂和溃疡。多位于左半结肠。病变多为一过型，如能早期诊断和治疗，多数预后良好。结论早期行结肠镜检查是诊断缺血性结肠炎的主要方法。     

Radiographic findings after incomplete pyloromyotomy

The gastrointestinal series of 10 patients with persistent vomiting following pyloromyotomies for pyloric stenosis were reviewed. Four patients had incomplete pyloromyotomies and required reoperation. Their studies showed persistent obstruction with elongation and narrowing of the pyloric channel similar to preoperative studies, except that the proximal muscle mass was tapered in 3 of the 4 patients. Six patients with similar histories of postpyloromyotomy vomiting but who did not require repeat surgery had irregular but much wider pyloric channels, good gastric emptying, and gastroesophageal reflux.     

Sonographic findings in Shigella colitis

We present a case of colitis caused by Shigella sonnei in which abdominal sonography helped in the early diagnosis, leading to successful conservative management. Sonography showed diffuse wall thickening and layer stratification in the descending and sigmoid colon. Although Shigella colitis is relatively rare, the possibility must be considered when patients have diffuse wall thickening with distinct layer stratification in the left colon.     

Sonographic findings in methamphetamine-induced ischemic colitis

Ischemic colitis is a clinicopathologic condition that commonly occurs in elderly patients with atherosclerotic disease or diabetes mellitus. Uncommon etiologies include vasculitis and use of drugs such as oral contraceptives, phenobarbital, nasal decongestants, dextroamphetamine, and cocaine. Recent studies have shown sonography and CT to be helpful in the evaluation of the colitides. We report the sonographic and CT findings in an unusual case of methamphetamine-induced ischemic colitis. Sonography and CT revealed diffuse thickening of the large bowel wall. Methamphetamine abuse should be considered in the differential diagnosis of the colitides, particularly in the setting of a young patient with a history of drug use and no other predisposing conditions. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:479–482, 1998.     

Necrotizing enterocolitis in acute leukemia: Radiographic findings

Acute gangrenous appendicitis or right lower quadrant necrotizing enterocolitis occurs with a high incidence in patients undergoing treatment for acute leukemia. In a series of 81 fully documented cases with complete charts and follow-up we identified seven surgically or pathologically proved cases of this syndrome. Plain radiographs of the abdomen were available in five of the seven cases, and a barium enema was performed on one. In three of the five cases the radiographic examination suggested or confirmed the nature of the right lower quadrant syndrome. Two of the seven patients were successfully treated by appropriate surgery. The radiographic findings in this series are reviewed and re-emphasized since an accurate diagnosis becomes important in appropriate management of this formerly uniformly fatal complication of acute leukemia and/or its therapy.     

缺血性结肠炎的临床及内镜研究

目的总结缺血性结肠炎的临床表现及内镜特征。方法对该院2000年以来经结肠镜确诊的43例缺血性结肠炎患者的临床及内镜资料进行回顾性总结分析。结果该病50岁以上中老年人易患(38/4388.1%),多数患者伴有高血压、心血管疾病、脑梗死和便秘等基础疾病或诱因。临床主要表现为突发左下腹部痛、便血、腹泻三联征。病变部位主要发生在左侧结肠,内镜下主要表现为病变肠段黏膜充血、水肿、糜烂、溃疡及增生性改变且与正常肠黏膜界限分明。结论中老年人出现急性腹痛及血便时应警惕缺血性结肠炎的可能,及早行结肠镜检查对明确诊断、早期治疗、判断预后具有重要意义。     

缺血性结肠炎的临床及内镜特点分析

目的总结缺血性结肠炎的临床特点和内镜表现,为缺血性结肠炎的诊断和治疗提供依据。方法回顾性分析29例缺血性结肠炎的病例资料。结果本组29例缺血性结肠炎平均年龄59.6岁,60岁以上者17例（58.6%）;23例患者（79.3%）至少合并一种或一种以上基础疾病;临床表现：24例（85.8%）出现阵发性剧烈腹痛,21例（72.4%）有便血症状。内镜下病变肠管呈节段性分布,与正常肠管界限清楚,病变肠管黏膜表现为不同程度充血、水肿,血管纹理不能分辨,散在糜烂和大小形态不同的溃疡,左半结肠多见。26例（89.7%）痊愈,3例（10.3%）好转。结论内镜医师应掌握缺血性结肠炎临床表现及内镜特点,对伴有动脉硬化等基础病变的老年人,若出现腹痛、血便,早期行肠镜检查。缺血性结肠炎及时诊断和治疗,预后一般良好。     

Splenic implant in the jejunum: Radiographic and pathologic findings

We report a patient in whom barium studies and computed tomography revealed an intramural mass in the jejunum that consisted pathologically of ectopic splenic tissue. Because the patient had a prior splenectomy, the lesion probably represented splenosis rather than an accessory spleen. When intramural lesions are detected on barium studies in patients who have had prior abdominal trauma or splenectomy,^99mTc-tagged, heated-red blood cell scintigraphy may be performed to confirm the diagnosis, thereby eliminating the need for surgery in these patients.     

Radiographic demonstration of longitudinal ulcers in patients with ulcerative colitis

During the past 10 years, 122 patients with ulcerative colitis were diagnosed by double-contrast barium enema and colonofiberscopy with endoscopic biopsy. Among them, five patients (4%) had longitudinal ulcers and eccentric deformities in the colon. Other radiologic findings included thumbprinting (two cases), sacculations (two cases), and inflammatory polyps (four cases). The possibility of the concomitance of ischemic colitis in cases of ulcerative colitis is discussed, due to their radiographic similarities.     

Ultrasonic and CT findings in penicillin-induced nonpseudomembranous colitis

The findings of ultrasonography (US) and computed tomography (CT) of the abdomen in two cases of nonpseudomembranous colitis (NPMC) induced by penicillin are described. Both imaging methods revealed diffuse thickening of the colon in patients who were endoscopically diagnosed as suffering from this disease. The clinical and radiographic features of this entity are presented along with a brief review of pertinent literature.     

Eosinophilic esophagitis: endoscopic findings

Eosinophilic esophagitis is a condition characterized by a dense infiltration of eosinophils within the epithelium that may extend into the deeper layers of the esophagus associated with distinctive endoscopic changes. The changes are frequently found in patients who have hypersensitivity to various foods and aeroallergens but overlap exists with gastroesophageal reflux disease. It is essential for all endoscopists to become familiar with the endoscopic findings of eosinophilic esophagitis to avoid delays or errors in diagnosis and to optimally assess outcomes of treatment.     

Gastric involvement by omental cakes: Radiographic findings

Six cases of malignancy (3 ovarian, 1 endometrial, 1 cecal, and 1 breast) were collected in which upper gastrointestinal (UGI) examinations revealed mass effect, nodularity, flattening, and/or spiculated mucosal folds on the greater curvature of the stomach due to contiguous spread of tumor from the greater omentum. Carcinoma of the transverse colon invading the stomach via the gastrocolic ligament may produce identical radiographic findings. In 3 cases, however, barium enema (BE) examinations revealed simultaneous involvement of the transverse colon by omental tumor as well as other evidence of intraperitoneal seeding. When a UGI examination suggests gastric involvement by omental metastases or so-called omental cakes, a BE should be performed to demonstrate associated colonic involvement and to rule out a carcinoma of the transverse colon as the cause of these radiographic findings.     

Amyloidosis of the gastric stump: Radiographic and CT findings

An unusual case of amyloid deposition in the wall of gastric pouch 15 years after surgery for peptic ulcer is presented. The radiographic and computed tomographic (CT) findings included marked thickening of the gastric wall associated with clusters of calcifications and ulcerated mucosa. These features are illustrated and the pertinent literature is briefly reviewed.