临床病例讨论 第465例——肠梗阻、消化道出血、十二指肠瘘

The 465th case： intestinal obstruction, gastrointestinal hemorrhage and duodenal fistula

这是1例复杂疑难病例。患者男，62岁以反复肠梗阻起病，先后两次经历回盲部及结肠手术，又出现不明原因消化道出血，经检查发现十二指肠降部巨大瘘，与回结肠吻合口相通，瘘管内溃疡出血。经多学科讨论，置入空肠营养管旷置瘘管，情况改善后行十二指肠瘘修补、病变肠管切除，术后病理确诊为克罗恩病，予沙利度胺维持治疗，病情稳定好转。

This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn＇s disease. The patient was treated with thalidomide and recovered well during follow-up.