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NEJM：缺血性结肠炎的拇指征-病例报道

2018-06-14 xing.T MedSci原创

缺血性结肠炎拇指腹痛
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这一影像学表现可见于缺血性结肠炎、伪膜性结肠炎和其他类型的感染性结肠炎，以及炎症性肠病的加重期。病人粪便检查艰难梭菌毒素阴性。直肠乙状结肠镜检查的结果与缺血性结肠炎的诊断一致。

患者为一名63岁的男性，因脐周区域开始腹痛，随后转移到左下象限3天而到急诊就诊。

体格检查显示腹部左下象限压痛。最初的实验室检查显示白细胞计数为每立方毫米12000（参考范围为4000至10000）和乳酸水平1.8mmol/L（正常值＜1.9）。腹部造影增强计算机断层扫描以评估复杂憩室疾病的可能性，显示乙状结肠水肿伴拇指征，该表征是由大肠水泡变厚并间隔一定时间进入到小肠腔内所致。



这一影像学表现可见于缺血性结肠炎、伪膜性结肠炎和其他类型的感染性结肠炎，以及炎症性肠病的加重期。病人粪便检查艰难梭菌毒素阴性。直肠乙状结肠镜检查的结果与缺血性结肠炎的诊断一致。

由于病人采取保守治疗后病情没有改善，包括静脉输液、抗生素、镇痛和肠道休息，接受剖腹探查。乙状结肠被发现坏死并切除，进行结肠造口术。患者病情逐渐好转，术后第八天出院。术后随访3个月，他仍无症状。

原始出处：
 
Dimitrios Manatakis,et al.Thumbprinting in Ischemic Colitis.N Engl J Med 2018.https://www.nejm.org/doi/full/10.1056/NEJMicm1715442
 
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    2019-03-26 guihongzh

    #缺血性#

    0

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    2018-06-19 1561f14951m

    哪位能详细讲解讲解CT表现啊

    0

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    2018-06-16 cscdliu

    学习了.谢谢

    0

  4. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 1ddf0692m34(暂无匿称)

    学习了.长知识

    0

  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 哈哈869

    学了

    0

  6. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 哈哈869

    学了

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Jun 14 08:01:10 CST 2018, time=2018-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=324027, encodeId=558532402eec, content=中间对CT的影像学描述没有说清楚.不能完全理解, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/HFYAgjUrb1qJvWgepemibjVL4ExGtaelJbxwicOZtFiaM2jvaXPKneOY2z2jNSWV65Sm41eVOv1KZnBf6BKpJhiayw/0, createdBy=147e2195636, createdName=朵朵的完美世界, createdTime=Thu Jun 14 07:50:30 CST 2018, time=2018-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=324007, encodeId=95d232400e16, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 明月清辉

    谢谢分享.学习了

    0

  8. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 飛歌

    厉害了我的哥

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 朵朵的完美世界

    中间对CT的影像学描述没有说清楚.不能完全理解

    0

  10. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Jun 14 07:04:05 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-14 深海的鱼

    学习学习学习

    0

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