脾切除后暴发性感染并缺血性结肠炎的诊治体会

Experience of diagnosis and treatment of an overwhelming postsplenectomy infection complicated with ischemic colitis

目的:提高对脾切除术后暴发性感染(OPSI)继发缺血性肠病的认识。方法:报道1例脾切除术后胰漏并暴发性感染,继发缺血性结肠炎患者的临床病历资料,结合文献分析诊治体会。结果:脾切除术后5 d发生胰漏、继之肝功能损害、脓毒症,粒细胞缺乏症,反复血便,3次选择性腹腔动脉造影示结肠动脉分支破裂出血,肠镜发现结肠多发溃疡性病变,病理学见黏膜散在坏死,呈缺血性慢性炎症改变,经认真细致的诊断治疗获痊愈。结论:脾切除术后易发生凶险感染,多脏器功能损害,甚至粒细胞缺乏症、缺血性肠病,应早期识别,积极的抗生素治疗。

Objective：To improve the understanding of overwhelming postsplenectomy infection complicated with ischemic colitis.Methods：A case of overwhelming postsplenectomy infection complicated with ischemic colitis was presented ; the experience of diagnose and treatment was discussed.Results：Pancreatic leakage occurred 5 days after splenectomy,and then followed by hepatic function damage,sepsis,agranulocytosis and repeated bloody stool.Mesenteric angiography showed bleedings from the intestinal mucosal blood vessels,colonoscopy showed multiple ulcerative colitis and pathological biopsy identified as ischemic colitis.Through careful and earnest diagnosis and treatment,the patient was healed eventually.Conclusion：Serious infection,multiple organ dysfunction,even agranulocytosis and ischemic bowel disease can occur after splenectomy,which should be recognized as soon as possible and treated with appropriate antibiotics.