缺血性大腸炎：病例報告

Ischemic Colitis: A Case Report

李秉學(Ping-Hsueh Lee) ； 陳恆順(Heng-Shuen Chen) ； 呂碧鴻(Bee-Horng Lue)

《臺灣家庭醫學研究》 5卷3期&4 (2007/10) Pp. 134-141

https://doi.org/10.29475/TFMR.200710.0005

摘要

因血液灌流不足而造成大腸的傷害及發炎，臨床上稱為缺血性大腸炎，其發生和許多臨床狀況有關，如栓塞、休克、低血容、主動脈手術和藥物等，相關危險因子包括年紀大、腸躁症和長期便秘等。臨床上的表現大多為腹痛及血便，而診斷上則以大腸鏡及病理切片為主。因缺血性大腸炎嚴重程度不一，故治療上除給予支持性療法外，更應密切觀察患者變化，留意是否有外科手術介入的必要。
本病例是一位76歲女性，主訴在腹痛、嘔吐及腹瀉之後出現血便已有一天，患者有高血壓、高血脂病史及便秘，長期服用降血壓藥物。來院初步診斷為缺血性大腸炎，經抗生素投予及支持療法後症狀改善出院。本文希望藉此病例，將缺血性大腸炎的生理病理機轉、流行病學、診斷、治療及預復作一回顧，藉以讓家庭醫師熟悉此疾病，俾能在從事臨床工作時有更高的敏感度。

並列摘要

Ischemic colitis is a disorder in which part of the colon becomes inflamed and injured due to decreased colonic perfusion. It has been associated with a number of diverse conditions, such as thrombo-embolism, shock, hypovolemia, aortic surgery and medications. Other related risk factors are age, irritable bowl syndrome and constipation. Common signs and symptoms of ischemic colitis include abdominal pain and passage of bloody stool. Colonoscopy and biopsy are often required to establish the diagnosis of ischemic colitis. Besides supportive care, the treatment of acute colonic ischemia has to monitor carefully the change and progression of the disease to decide whether the surgical intervention is necessary.
Here we presented a 76 year-old female, with a history of medication-controlled hypertension, hyperlipidemia and constipation, complaining of abdominal pain and bloody stool after bouts of vomiting and diarrhea for 1 day. She was admitted with tentative diagnosis of ischemic colitis and later discharged with improvement after given antibiotics and supportive care. We hope primary care physicians can get more familiar with this disease through the presentation of the pathophysiology, epidemiology, diagnosis, treatment and prognosis of ischemic colitis.

並列關鍵字

ischemic colitis ； hematochezia ； risk factors ； colon ； intestinal ischemia