背景:静脉血栓栓塞是炎症性肠病(IBD)的常见并发症之一,这是全球范围内的重大健康问题。炎症等因素,药物,还有腹部手术,有助于增加IBD患者静脉血栓栓塞的风险。门静脉海绵样变性(CTPV)是IBD较为罕见的并发症。随后的门静脉高压可能是致命的,临床治疗困难。因此,早期预防非常关键。
方法:一名55岁的男子因虚弱出现在我们部门,呕血,和腹泻。他被诊断患有克罗恩病9年。两年前,他患有肠穿孔,并接受了肠切除术和回肠造口术。And,在围手术期和手术后,由于有消化道出血史,未给予抗凝剂.
方法:对患者进行内镜检查,显示食管和贲门附近胃底静脉曲张。增强CT扫描显示门静脉高压,CTPV,胃食管静脉曲张,脾肿大.然后进行经皮肝穿刺门静脉造影以明确诊断。
方法:关注手术的风险,他拒绝手术分流.由于技术困难,建议保守治疗,而不是介入治疗。
结果:禁食一段时间后,输血,和肠外营养治疗,患者没有出现任何进一步的呕吐或呕血。
结论:CTPV的早期识别和治疗是困难的。IBD手术患者需要早期应用抗凝剂等预防,特别是同时造口形成。对于不适合抗凝治疗的IBD患者,术后随访监测应更频繁,监测时间应延长。
BACKGROUND: Venous thromboembolism is one of the common complications of inflammatory bowel disease (IBD), which is a significant health problem worldwide. Factors such as inflammation, medications, and abdominal surgery, contribute to the increased risk of venous thromboembolism in patients with IBD. Cavernous transformation of the portal vein (CTPV) is a relatively rare complications of IBD. Subsequent portal hypertension could be fatal and the clinical treatment is difficult. Thus, early prevention is very crucial.
METHODS: A 55-year-old man presented to our department with asthenia,
hematemesis, and diarrhea. He was diagnosed with Crohn disease for 9 years. Two years ago, He suffered intestinal perforation and received enterectomy and ileostomy. And, anticoagulants were not given during perioperative period and after surgery because of the history of gastrointestinal bleeding.
METHODS: The patient was given endoscopy inspection showing the varices of esophagus and gastric fundus near cardia. Contrast enhancement CT scan showed portal hypertension, CTPV, gastroesophageal varices, and splenomegaly. Then percutaneous transhepatic portography was performed to make a clear diagnosis.
METHODS: Concerned about the risk of surgery, he refused surgical shunting. Conservative treatment was recommended due to technical difficulties instead of interventional therapy.
RESULTS: And after a period of fasting, blood transfusion, and parenteral nutrition treatment, the patient did not experience any further vomiting or
hematemesis.
CONCLUSIONS: Early identification and treatment of CTPV is difficult. Prevention such as early application of anticoagulant is necessary for patients with IBD undergoing surgery, particularly with simultaneous stoma formation. For IBD patients who are not suitable for anticoagulant therapy, postoperative follow-up monitoring should be more frequent and monitoring time should be extended.