肝硬化併發十二指腸靜脈曲張出血之一病例報告

Bleeding Duodenal Varices with Cirrhosis of the Liver: A Case Report

高進祿(Chin-Roa Kao) ； 陳漢湘(Han-Shiang Chen) ； 陳世澤(Shin-Tzer Chen) ； 陳哲雄(Jer-Shon Chen)

《中華民國消化系醫學會雜誌》 1卷1期 (1984/01) Pp. 38-41

https://doi.org/10.6557/GJTa.198401_1(1).0006

摘要

十二指腸靜脈曲張是門靜脈系統側枝循環的一種併發症，至為罕見，文獻上報告的病例大都在開刀後或屍體解剖時才確定診斷。本文所報告的病例，是一位55歲的女性患者，過去除偶發性的上腹部疼痛外，並無其它顯著症狀。於入院前一天，突有大量鮮紅色與黑色混雜之血便，原以為是下消化道出血。入院後轉為大量咖啡色嘔吐物，才由泛上消化道內視鏡診斷出十二指腸靜脈曲張出血，但食道並為靜脈曲張，開刀證實十二指腸靜脈曲張出血並且有肝硬化。對於一個門脈高壓症併發胃腸出血的病人，除非泛上消化道內視鏡或脾門靜脈攝影可以摒除十二指腸第二部分以下出血的可能性，否則十二指腸靜脈曲張出血的可能，應深加考慮，不可掉以輕心，是我們經驗此病例最大的心得。

並列摘要

duodenal varices;portal hypertension;panendoscopy
Duodenal varices are very rare collateral circulation in portal hypertension. Only 35 cases of duodenal varices unassociated with esophageal varices have been noted in the English literature up to 1977. Because of the limited clinical experience, most cases were proved after exploratory laparotomy or autopsy. We describe a 55-year-old female patient who only suffered from occasional aggravated postprandial epigastralgia in the past, and suddenly had melena mixed with fresh bloody stool 1 day prior to her admission. Our first impression was lower 0-I bleeding, but sigmoidoscopic examination revealed blood clots only. One and half an hour after sigmoidoscopy, the patient turned to have hematemesis. Bleeding duodenal varices were found during an emergent panendoscopic examination. There was no esophageal varix. Laparotomy revealed a cirrhotic liver and confirmed the bleeding duodenal varices. So, when we treat a patient with portal hypertension with GI bleeding, hemorrhage from duodenal varices should be kept in mind and endoscopy or splenoportography is very helpful in evaluating the source of bleeding.

並列關鍵字

duodenal varices ； portal hypertension ； panendoscopy