Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis
Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis
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DOI：
10.3748/wjg.v12.i36.5913
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发表时间：
2006-09-28
影响因子：
4.3
通讯作者：
Yamamura, Takehira
中科院分区：
文献类型：
--
作者：
Ikeuchi, Hiroki;Hori, Kazutoshi;Yamamura, Takehira
我们经历了一个非常罕见的情况下，溃疡性结肠炎（UC）伴有类似病变的胃，十二指肠，回肠J袋。1996年，对一名29岁女性进行回肠J型贮袋肛门吻合术。6年后，她因上腹痛、恶心、水样腹泻和低热再次入院。根据内视镜检查的结果，我们诊断为结肠袋炎。此外，在低张十二指肠造影中，十二指肠球部和降部的扩张较差。Kerckring褶皱消失，具有典型的铅管外观。该患者的胃和十二指肠病变的发病机制与UC的结肠病变相似。对于该患者的胃十二指肠病变，在连续给予奥美拉唑的同时给予14天的美沙拉秦碎片（1500 mg/d）后，症状缓解。首先，我们使用环丙沙星治疗结肠袋炎。第五天，她因导管感染发烧。在导管培养中，检测到耐甲氧西林金黄色葡萄球菌（MRSA）。因此，我们将环丙沙星变更为盐酸万古霉素（万古霉素（R））。万古霉素非常有效，大便频率在三天内显著改善。现在她继续服用美沙拉秦，但她的病情稳定，结肠袋炎没有复发。(C)2006年，WJG出版社。All rights reserved.
We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J-pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin(R)). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis. (C) 2006 The WJG Press. All rights reserved.