508
508
复制标题
508
DOI：
10.1097/01.ccm.0000551260.51522.c3
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发表时间：
2019
影响因子：
8.8
通讯作者：
P. Mir
中科院分区：
文献类型：
--
作者：
Dora Izaguirre ;N. Tandan;H. Liao;Remi T. Okwechime;O. Adarkwah;Z. Thet;T. Mir;P. Mir
方法：33 岁女性主诉持续两周未缓解的剧烈腹痛。她提到，在入住 ICU 之前，她曾寻求医疗救助，在那里她进行了食管胃十二指肠镜检查 (EGD)，显示胃炎并被诊断患有肠易激综合症。她过去的病史包括子宫肌瘤、月经过多、严重缺铁性贫血以及长期酗酒（EtOH）但未使用消遣性药物。她有3次不复杂的剖腹产史，并否认使用口服避孕药。系统回顾与不适、恶心、腹泻、顽固性腹痛和排尿困难相关。入院时的生命体征温度为 98.9 F，脉搏 79 bpm，呼吸 16 次/分钟，血压 115/71 mmHg，室内空气中脉搏血氧饱和度为 99%。与上腹部触诊严重压痛相关的体格检查。粪便愈创木脂呈阴性。入院时 CBC 7.84 个细胞/uL，Hgb 7.6 g/dL，MCV 54.9，RDW 19.7。为评估急性胆囊炎而进行的腹部超声检查显示，没有胆囊液或炎症，胆总管大小为 0.25 厘米，肾脏大小正常，脾脏大小为 9.5 厘米。腹部和骨盆 CT 扫描（静脉造影）显示，肠系膜静脉至门静脉汇合处存在广泛的肠系膜血栓，肝右叶和左叶还存在肝内门静脉血栓。血液科建议抗凝治疗。介入放射学成功地使用阿替普酶进行了导管引导溶栓，没有出现并发症。她出院后接受长期抗凝治疗。结果：急性 BCS 和 MVT 联合或单独治疗均可能危及生命。早期识别的延迟会对生存产生不可逆转的影响，因此及时抗凝和多学科治疗至关重要
Methods: 33 year-old female complaints of non-resolving severe abdominal pain of two weeks of duration. She refers seeking medical attention prior to her admission to ICU where she had performed an esophagogastroduodenoscopy performed (EGD) showing gastritis and diagnosed with irritable bowel syndrome. Her past medical history was significant for uterine fibroids, menorrhagia, severe iron deficiency anemia, and chronic alcohol (EtOH) use with no use of recreational drugs. She had history of three uncomplicated C-sections and denied the use of oral contraception. Review of systems was pertinent for malaise, nausea, diarrhea, intractable abdominal pain and dysuria. Vitals on admission-temperature was 98.9 F, pulse 79 bpm, respirations 16/minute, blood pressure 115/71 mmHg, pulse oxymetry 99% on room air. Physical Exam pertinent for severe tenderness to palpation on epigastrium with guarding. Stool guaiac was negative. CBC on admission 7.84 cells/uL, Hgb 7.6 g/dL, MCV 54.9, RDW 19.7. An abdominal sonogram performed to evaluate for acute cholecystitis, was pertinent for no cholecystic fluid or inflammation, common bile duct size of 0.25 cm, normal kidney sizes, and spleen size of 9.5 cm. CT scan of the abdomen and pelvis with IV contrast showed extensive mesenteric thrombus in the mesenteric vein to the portal confluence with additional intrahepatic portal venous thrombosis right and left lobes of the liver. Hematology recommended anticoagulation therapy. Interventional radiology performed a successful catheter-directed thrombolysis with alteplase and no complications. She was discharged in long-term anticoagulation therapy.Results: Acute BCS and MVT combined or alone are potentially life threatening conditions. Delays in early recognition can irreversibly impact on survival thus prompt anticoagulation and multidisciplinary approach is crucial