- 期刊
Segmental Dilatation of the Ileum As an Unusual Cause of Gastrointestinal Bleeding: Report of One Case
迴腸節段性擴張爲消化道出血之不尋常病因：一病例報告
摘要
本文報告一例患有迴腸節段性擴張的十個月大男嬰，真實以間歇性黑便及貧血症表現，並沒有腹脹及嘔吐等腸阻塞症狀發生。更深檢查可風病童臉色蒼白，腹部柔軟無腹脹。肛診檢查趄甩手並無息肉，卻可見褐色糞便中夾雜黑色油狀之糞便。實驗室數排除出血傾向、溶血性貧血及鉛中毒的可能性。在住院期間，我們給予禁食、靜脈輸液，制酸劑以及紅血球輸血等支持性治療。所有檢查包括上消化道內視鏡檢查、鎝-99m梅克耳氏憩室掃描、及雙重對比大腸攝影皆無法發現病竈；唯獨鎝-99m標定紅血球出血掃描檢查發現小腸有不正常出血。因爲持續性原因不明的消化道出血，於是在病童十三個月大時初等探查性剖腹術，證實診斷爲迴腸節段 性擴張。病理檢查此節段 性擴張迴腸肌肉層正常，並無異位性組織存在。此一罕見病症多以腸阻塞症狀表現，惟本例報告顯示：此症可單獨以消化道出血的症狀表現，幫提出本例，並回顧文獻報告，對致病機轉作一探討。
並列摘要
We report a case of segmental dilatation of the ileum in a 10-month-old male infant. Intermittent loose black-colored stool passage and normocytic anemia were noted at the initial visits to our hospital. There was no symptom or sign of intestinal obstruction such as abdominal distention or vomiting. On physical examination, he was found to be pale but his abdomen was soft and flat. Digital examination revealed brownish stool tinged with black-colored oil-like stool but no polyp. Laboratory studies excluded coagulopathy, hemolytic anemia and lead poisoning. During hospitalization, he was treated with nothing per mouth, intravascular fluids, ranitidine, and transfusion of packed red blood cells. All examinations including panendoscopy, Technetium-99m((superscript 99m)Tc)-pertechnetate Meckel's diverticulum scan, and double contrast colon series revealed no organic lesion except that (superscript 99m)Tc-red blood cell bleeding scans showed abnormal bleeding in the small intestine. Because of his persistent gastrointestinal bleeding with unknown cause, we did an exploratory laparotomy when the patient was 13 months old and idiopathic segmental dilatation of the ileum was confirmed. The dilated segment is supposed to be idiopathic because of histologically proven normal muscle layers without ectopic tissue. This case suggests that segmental dilatation of the ileum can only present as gastrointestinal bleeding without intestinal obstruction.
延伸閱讀
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