肠系膜上静脉血栓静脉炎合并脆弱拟杆菌感染1例  

Superior mesenteric veinous thrombosis with Bacteroides fragilis infection:a case report

作　　者：陈丽慧 申彩云 CHEN Li-hui;SHEN Cai-yun(Jincheng People's Hospital,Jincheng,Shanxi 048000,China)

机构地区：[1]晋城市人民医院,山西晋城048000

出　　处：《中国热带医学》2023年第5期560-562,共3页China Tropical Medicine

基　　金：晋城市人民医院院级课题项目(No.JSY-2021G001)。

摘　　要：肠系膜上静脉血栓静脉炎是一种罕见的疾病,常合并腹腔内疾病,如憩室炎、阑尾炎、炎症性肠病等。该病起病隐匿,临床表现主要为发热、腹痛,无特异性症状,诊断取决于临床实验室检查和影像学检查。肠系膜上静脉血栓静脉炎发生与含有细菌的栓子脱落后随血流进入门静脉导致脓毒性静脉炎有关。由于其临床表现多无特异性,从临床特征和微生物学方面诊断此病面临着挑战。现报道1例脆弱拟杆菌(Bacteroides fragilis)感染致肠系膜上静脉脓毒性血栓静脉炎病例,为诊治该类疾病提供参考。患者为34岁男性,以间断腹痛和发热入院,计算机断层扫描(CT)显示肠系膜上静脉部分血栓形成,结肠镜检查显示回盲部憩室炎,血培养长出脆弱拟杆菌。经抗感染(头孢他啶2.0 g,每12 h1次,静脉滴注,共计11 d;甲硝唑0.5 g,每8 h 1次,静脉滴注,共计3 d)和抗凝(利伐沙班20 mg,每日1次,口服,共计8 d)治疗,入院第11天好转出院。通过此病例,对于发热和腹痛患者应将肠系膜上静脉血栓静脉炎纳入鉴别诊断,通过辅助检查、血标本培养等技术,及时明确诊断,改善患者预后。Superior mesenteric veinous thrombosis(SMVT)is a rare complication that often occurs in conjunction with intra-abdominal diseases such as diverticulitis,appendicitis,inflammatory bowel disease,etc.Its clinical symptoms are nonspecific and include fevers,abdominal pain;it has no specific symptoms,and the diagnosis depends on clinical laboratory tests and imaging studies.The occurrence of superior mesenteric veinous thrombophlebitis is related to septic phlebitis caused by the sloughing of the embolus containing bacteria into the portal vein with blood flow.Due to the nonspecific clinical features of this disease,diagnosing it based on clinical characteristics and microbiological aspects is a challenge.A case of superior mesenteric veinous septic thrombophlebitis caused by Bacteroides fragilis infection is reported and to provide a reference for the diagnosis and treatment of such diseases.The patient was a 34-year-old man who was admitted the hospital with intermittent abdominal pain and fever.Computed tomography(CT)showed partial thrombosis of the superior mesenteric vein,colonoscopy revealed diverticulitis in the ileoceca,and the blood culture grew Bacteroides fragilis.The patient was treated with anti-infection(ceftazidime 2.0 g q12h intravenous infusion for 11 days;metronidazole 0.5 g,q8h intravenous infusion for 3 days)and anticoagulation(rivaroxaban 20 mg qd orally for 8 days.On the 11th day of hospitalization,the patient's condition improved,and he was discharged.In this case,for patients with fever and abdominal pain,superior mesenteric venous thrombophlebitis should be included in the differential diagnosis.Through auxiliary examination,blood sample culture and other technologies,clear diagnosis should be made in time to improve patient outcomes.

关 键 词：发热 腹痛 肠系膜上静脉血栓静脉炎 脆弱拟杆菌 

分 类 号：R572.3[医药卫生—消化系统] R378.8[医药卫生—内科学]