The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Ischemic Duodenal and Jejunal Enteritis in a Patient with Chronic Splanchnic Disease

만성내장질환 환자에서 발생한 십이지장 및 공장의 허혈성 장염 1예

  • Kim, Gun-Min (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Yong-Cheol (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Park, Jin-Min (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Hong, Seok-In (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Jin-Il (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Park, Soo-Heon (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Jae-Kwang (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 김건민 (가톨릭대학교 의과대학 내과학교실) ;
  • 김용철 (가톨릭대학교 의과대학 내과학교실) ;
  • 박진민 (가톨릭대학교 의과대학 내과학교실) ;
  • 홍석인 (가톨릭대학교 의과대학 내과학교실) ;
  • 김진일 (가톨릭대학교 의과대학 내과학교실) ;
  • 박수헌 (가톨릭대학교 의과대학 내과학교실) ;
  • 김재광 (가톨릭대학교 의과대학 내과학교실)
  • Published : 2012.06.01
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Abstract

Gastrointestinal ischemia happens by splanchnic artery stenosis, thrombus, or physiological vasoconstriction during a low-blood-stream state. However, even if arterial stenosis exists in the upper gastrointestinal tract, ischemic injury is very rare due to rich collateral circulation. The authors experienced 92-year-old female patient with vomiting, epigastric pain, and hematemesis. An electrocardiogram showed paroxysmal atrial fibrillation. The patient had diffuse and segmental mucosal edema, erythema, and hemorrhage in the second part of the duodenum on esophagogastroduodenoscopy (EGD). On abdomen computed-tomography angiography, stenosis of the celiac and superior mesenteric arteries was observed, and segmental concentric wall thickness was seen from the proximal second portion of the duodenum to the proximal jejunum. The patient was treated with PPI and fluid therapy for one week. At follow-up EGD, the mucosa had improved compared with the previous EGD examination. In conclusion, ischemic injury rarely affects the duodenum and jejunum; however, it can develop in the presence of inducing factors.

위장관 허혈은 내장동맥 협착, 혈전 및 저혈류 상태의 혈관수축에 의해 발생한다. 하지만 상부위장관에 동맥협착이 있다고 해도 풍부한 측부순환으로 허혈성 손상은 드물다. 저자들은 구토, 상복통 및 토혈을 주소로 내원한 92세 여자 환자를 경험하였다. 심전도에서 발작성 심방세동을 가지고 있었다. 환자는 상부위장관 내시경에서 십이지장 제2부에 미만성 분절형태의 점막 부종, 홍반 및 출혈을 보였다. 복부 혈관조영 전산화 단층촬영에서 복강동맥과 상장간막동맥의 협착이 있었고 십이지장 제2부의 근위부부터 공장의 근위부까지 분절형 동심성 비대가 보였다. 환자는 일주일 동안 양전자 펌프 억제제 및 수액치료를 받았다. 추적 상부위장관 내시경에서 이전 검사에 비해 호전된 점막을 관찰할 수 있었다. 결론적으로 십이지장 및 근위부 공장은 혈액순환이 매우 풍부하여서 허혈성 손상이 발생하는 경우는 매우 드물지만 만성내장질환을 가지고 있는 환자에서 유발인자로 인해 발생할 수 있다는 사실에 주의해야 한다.

Keywords

References

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