以假性肠梗阻为首发表现的重症狼疮肠系膜血管炎1例报道

Severe Lupus Mesenteric Vasculitis with Pseudointestinal Obstruction as The First Manifestation:A Case Report

目的探讨以假性肠梗阻为首发临床表现的重症狼疮肠系膜血管炎诊断与治疗。方法1例重症狼疮肠系膜血管炎患者在2021年11月于广东省珠海市人民医院就诊,分析其临床症状、影像学表现得出初步诊断。因诊断不明确,后经过进一步检查及科室讨论,从而确定最终诊断,并给予有效治疗。结果女性患者31岁,因腹痛、腹胀、腹泻、呕吐入院,查体提示中上腹压痛,全腹反跳痛,肠鸣音减弱。腹部CT提示肠壁水肿,肠腔积液扩张,小肠旋转不良较肠扭转可能性大,CRP、PCT高,结合抗核抗体谱多项阳性,经科内讨论,最终诊断为:狼疮肠系膜血管炎(重症)。给予以腹腔穿刺引流、激素冲击抗炎、低分子肝素抗凝、肠内营养等治疗后,症状改善。结论以假性肠梗阻为首发表现的重症狼疮肠系膜血管炎,应详细询问患者症状,完善查体,辅助检查,全面分析,早期诊断。

Objective To explore the diagnosis and treatment of severe lupus mesenteric vasculitis with pseudoileus as the first manifestation.Methods One patient with severe lupus mesenteric vasculitis was presented in Zhuhai People's Hospital,Guangdong Province in November 2021.The clinical symptoms and imaging findings were analyzed to obtain the initial diagnosis.Due to the unclear diagnosis,after further examination and the discussion within our department,the final diagnosis was determined.Lastly,the patient was given effective treatment.Results The 31-year-old female patient was admitted to the hospital with abdominal pain,abdominal distension,diarrhea,and vomiting.Physical examination indicated upper abdominal pain and decreased bowel sounds.The abdominal CT examination suggested intestinal wall edema,expansion of intestinal lumen effusion,poor rotation of the small intestine was more likely than intestinal torsion,and CRP as well as PCT was high.Moreover,the spectrum of anti-nuclear antibody is multiple positive.After the department discussion,the revised diagnosis is lupus mesenteric vasculitis(severe).The patient was treated with peritoneal puncture and drainage,anti-inflammatory with hormonal shocks,anticoagulation with low molecular weight heparin and enteral nutrition,and then received small-dose hormone sequential maintenance treatment.Then the patient's symptoms were relieved.Conclusion It is patients with severe lupus mesenteric vasculitis with pseudointestinal obstruction as the first manifestation that should be asked about their symptoms in detail,to complete the physical examination,auxiliary examination.Perform comprehensive analysis to diagnose as early as possible.