肠内营养治疗克罗恩病患者合并肠狭窄及胶囊内镜嵌顿一例

One case report for management of a Crohn’s disease patient with enteric stenosis and capsule endoscope incarceration by enteral nutrition

一例39岁男性因“大便不成形2年,腹痛伴发热2月”就诊北京协和医院。患者存在显著的进食减少、体质量减轻、血沉率(ESR)及超敏C反应蛋白(hs-CRP)升高和营养风险筛查2002评分5分。计算机X射线断层扫描(CT)提示肠狭窄、肠内瘘、腹腔脓肿,胶囊内镜嵌顿。北京协和医院排除肠结核后诊断为克罗恩病(CD)。经4个月足量的药物治疗及抗感染治疗,患者炎性反应指标明显下降,但肠狭窄等并发症未明显缓解,胶囊内镜持续嵌顿。后通过全肠内营养(TEN)配合药物治疗,患者肠狭窄缓解,肠内瘘闭合,腹腔脓肿消失,嵌顿的胶囊内镜自行排出。本病例提示,CD患者的肠狭窄等并发症对药物反应不佳;且不存在必须手术的情况,如完全肠梗阻时,肠内营养可作为营养支持的选择。其能够达到诱导黏膜愈合、水肿消退和梗阻缓解的目标,最终实现并发症的缓解。

A 39-year-old male visited Peking Union Medical College Hospital with chief complain of loose stool for 2 years and abdominal pain with fiver for 2 months.He had poor appetide and significant loss of weight.His erythrocyte sedimentation rate(ESR)and high sensitive-C reactive protein(hs-CRP)markedly increased and Nutritional Risk Screening 2002(NRS 2002)scored 5.CT scan revealed enteral stenosis with capsule endoscope incarceration,also entero-enteric fistula and abdominal abscess.Diagnosis of Crohn's disease(CD)was made after excluding enteral tuberculosis.Following 4-month full-dose mesalamine and antibiotics therapy,complications didn't improve although ESR and hs-CRP decreased evidently.Total enteral nutrition(TEN)was chosen instead of surgery.Finally,closure of fistula,disappearance of abscess,and discharge of capsule endoscopy with relief of stenosis was achieved.This case shows the promising role of enteral nutrition when handling Crohn's disease patients with multi-complications in surgery-free situations.