临床病例讨论 第465例——肠梗阻、消化道出血、十二指肠瘘  

The 465th case： intestinal obstruction, gastrointestinal hemorrhage and duodenal fistula

作　　者：王亚楠[1] 李晓青[1] 郭帆[2] 杨爱明[1] 钱家鸣[1] 李景南[1] 薛华丹[3] 周炜洵[4] 马志强[5] Wang Ya＇nan;Li Xiaoqing;Guo Fan;Yang Aiming;Qian Jiaming;Li Jingnan;Xue Huadan;Zhou Weixun;Ma Zhiqiang(Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院消化内科,北京100730 [2]中国医学科学院 北京协和医学院 北京协和医院内科,北京100730 [3]中国医学科学院 北京协和医学院 北京协和医院放射科,北京100730 [4]中国医学科学院 北京协和医学院 北京协和医院病理科,北京100730 [5]中国医学科学院 北京协和医学院 北京协和医院基本外科,北京100730

出　　处：《中华内科杂志》2018年第8期614-616,共3页Chinese Journal of Internal Medicine

基　　金：北京协和医学院2017年教学质量工程项目（2017zlgc0110）

摘　　要：这是1例复杂疑难病例。患者男，62岁以反复肠梗阻起病，先后两次经历回盲部及结肠手术，又出现不明原因消化道出血，经检查发现十二指肠降部巨大瘘，与回结肠吻合口相通，瘘管内溃疡出血。经多学科讨论，置入空肠营养管旷置瘘管，情况改善后行十二指肠瘘修补、病变肠管切除，术后病理确诊为克罗恩病，予沙利度胺维持治疗，病情稳定好转。This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn＇s disease. The patient was treated with thalidomide and recovered well during follow-up.

关 键 词：CROHN病 肠梗阻 胃肠出血 十二指肠瘘 

分 类 号：R57[医药卫生—消化系统]