隐源性多灶性溃疡性狭窄性小肠炎1例

Cryptogenic multifocal ulcerous stenosing enteritis: A report of one case and review of the literature

隐源性多灶性溃疡性狭窄性小肠炎(cryptogenic multifocal ulcerous stenosing enteritis,CMUSE),由于多部位、多灶性浅溃疡、多部位狭窄导致患者出现慢性、反复发作性轻中度腹痛等症状.他以对糖皮质激素治疗反应良好为特征.本文报道1例CMUSE,女性,77岁,表现为腹绞痛、肠梗阻和体重减轻、贫血、营养不良等,肠镜发现小肠多部位纤维狭窄和溃疡,对糖皮质激素治疗有反应,严重的连续多部位小肠狭窄可用双气囊小肠镜扩张治疗.总之,当有慢性、轻中度肠梗阻,多灶性小肠溃疡、多部位小肠狭窄及无确定病因时,应考虑为CMUSE.双气囊小肠镜可准确诊断,合理的内镜下治疗可减少手术,避免小肠过多切除.

Cryptogenic multifocal ulcerous stenosing enteritis （CMUSE） is a rare condition characterized by chronic or relapsing moderate ileus episodes resulting from multiple small intestinal strictures, multiple superficial ulcers of the small bowel and favorable therapeutic effect of glucocorticosteroids. Here we report a case of CMUSE in a 77-year-old female who presented with colicky pain, repeated moderate ileus episodes and weight loss. Multiple fibrous strictures and ulcers of the small bowel were found. The patient responded to glucocorticosteroid treatment. Severe tandem tight jejunal stenosis may be dilated endoscopically by means of double balloon enteroscopy. CMUSE should be considered when chronic moderate ileus episodes and multiple small intestinal strictures and ulcers of uncertain etiology are found. Double balloon enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenosis, and may obviate the need for surgery and prevent excessive small bowel resections.