老年肠系膜动脉栓塞致小肠出血患者的急诊诊治分析:附一例报道

Emergency Diagnosis and Treatment of Small Intestinal Hemorrhage Caused by Superior Mesenteric Artery Embolism in Elderly Patients: A Case Report

肠系膜动脉栓塞为少见的肠管缺血性疾病,若不及时治疗会因为感染导致死亡,病死率极高,早期手术是本病的主要治疗手段。本文报道1例反复胃镜和肠镜检查均未明确原因,并且怀疑小肠出血而入北京军区总医院急诊科就诊,最后确诊为症状不典型的肠系膜动脉栓塞患者的诊治过程。本例患者病程初期误诊为小肠肿瘤,完善小肠仿真CT并且行肠系膜血管造影,后确诊为肠系膜上动脉主干远端中断闭塞。提示对于老年患者不明原因消化道出血时,急诊医师应考虑肠系膜动脉栓塞引起缺血性肠病的可能,选择合理的影像学检查并结合患者病史和实验室检查结果及早诊断、及早治疗可提高患者救治成功率。

Mesenteric artery embolization is a rare intestinal ischemic disease. If the patients are not treated in time,the infection will lead to death and a high mortality rate. Its main therapeutic means is doing surgery early. This paper reports the process of the diagnosis and treatment of one patient who was admitted into the Emergency Department of the Military General Hospital of Beijing PLA due to suspected small bowel bleeding after no definite reasons were found after recurrent endoscopy and colonoscopy examinations,and was later definitely diagnosed as atypical superior mesenteric artery embolism. The patient was misdiagnosed as small intestinal tumor during the early stages. After improving the intestinal CT simulation and mesenteric angiography,it was diagnosed as superior mesenteric artery distal occlusion. We suggest emergency physicians should consider the possibility of mesenteric artery embolization inducing ischemic bowel disease in the case of elderly patients with unexplained gastrointestinal bleeding. The rational choice of imageological examination combined with the medical history of patients and laboratory examination results,as well as early diagnosis and treatment may improve the success rate of the treatment.