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Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon

World Journal of Gastroenterology 2017年第21期23卷 3934-3944页

作者： Zong-Ming Zhang Xiang-Chun Lin Li Ma An-Qin Jin Fang-Cai Lin Zhuo Liu Li-Min Liu Chong Zhang Na Zhang Li-Juan Huo Xue-Liang Jiang Feng Kang Hong-Jun Qin Qiu-Yang Li Hong-Wei Yu Hai Deng Ming-Wen Zhu Zi-Xu Liu Bai-Jiang Wan Hai-Yan Yang Jia-Hong Liao Xu Luo You-Wei Li Wen-Ping Wei Meng-Meng Song Yue Zhao Xue-Ying Shi Zhao-Hui Lu Department of General Surgery Beijing Electric Power HospitalState Grid Corporation of ChinaCapital Medical University Department of Gastroenterology Peking University International Hospital Asian Liver Center and Department of Surgery School of MedicineStanford University Department of Gastroenterology Beijing Electric Power HospitalState Grid Corporation of ChinaCapital Medical University Department of Gastroenterology First HospitalShanxi Medical University Department of Gastroenterology Jinan Military General Hospital Department of Radiology Beijing Electric Power HospitalState Grid Corporation of ChinaCapital Medical University Department of Pathology Beijing Electric Power HospitalState Grid Corporation of ChinaCapital Medical University Department of Pathology Peking University Third HospitalSchool of Basic Medical SciencesPeking University Health Science Center1 Department of Pathology Peking Union Medical College HospitalChinese Academy of Medical Sciences

A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of druginduced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.

关键词： benign colonic stenosis Compound Qingdai pill Self-expandable memory metallic stent

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