Massive lower gastrointestinal bleeding from intestinal varices.
Massive lower gastrointestinal bleeding from intestinal varices.
复制标题
肠静脉曲张导致下消化道大量出血。
作者：
S. Wilson;R. Stone;J. Christie;E. Passaro
肠静脉曲张引起的下消化道出血，术中不易发现；因此，术前识别很重要。我们对六名因肠静脉曲张而直肠突然大量出血的患者进行治疗的经验表明了一组常见的发现。这些患者患有肝硬化，胃或十二指肠无血，钡剂灌肠有特征性粘膜印记，乙状结肠镜或结肠镜检查可直接观察到静脉曲张。只有两人有明显的食管静脉曲张。 5 例患者经选择性肠系膜血管造影确诊，静脉曲张部位位于静脉期。两名患者的静脉曲张位于十二指肠空肠，两名患者的静脉曲张位于盲肠和升结肠，两名患者的静脉曲张位于直肠和乙状结肠。 3 名患者接受了肠系膜上动脉输血和动脉内注射加压素的非手术治疗；一名死亡。一名盲肠静脉曲张患者接受了右半结肠切除术，控制了出血，但进行性肝衰竭导致术后死亡。其余两名患者通过门体分流术成功对左结肠静脉曲张进行减压。
Lower gastrointestinal bleeding from intestinal varices cannot readily be detected at operation; hence, preoperative identification is important. Our experience with six patients having sudden, massive bleeding per rectum from intestinal varices suggests a group of common findings. These patients had cirrhosis, no blood in the stomach or duodenum, characteristic mucosal imprints on barium enema, or direct visualization of varices on sigmoidscopy or colonoscopy. Only two had demonstrable esophageal varices. The diagnosis was confirmed and the site of the varices localized on the venous phase of selective mesenteric angiography in five patients. Varices were located in the duodenojejunum in two, in the cecum and ascending colon in two, and in the rectum and sigmoid colon in two patients. Three patients were treated nonoperatively with transfusion and intraarterial infusion of vasopressin into the superior mesenteric artery; one died. One patient with cecal varices had a right hemicolectomy that controlled the bleeding, but progressive hepatic failure resulted in postoperative death. The remaining two patients had successful decompression of left colonic varices by portasystemic shunt.