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中华胃肠内镜电子杂志 ›› 2019, Vol. 06 ›› Issue (03) : 113 -117. doi: 10.3877/cma.j.issn.2095-7157.2019.03.004

所属专题: 经典病例 文献

论著

与α葡萄糖苷酶抑制剂相关的肠气囊肿症1例并临床分析
覃弦1, 李刚平1, 杜凡1, 宋军1,(), 侯晓华1   
  1. 1. 430022 武汉,华中科技大学同济医学院附属协和医院消化内科
  • 收稿日期:2019-07-11 出版日期:2019-08-15
  • 通信作者: 宋军
  • 基金资助:
    国家自然科学基金(81670488)

Pneumatosis cystoides intestinalis associated with alpha-glucosidase inhibitors: a case report and clinical analysis

Xian Qin1, Gangping Li1, Fan Du1, Jun Song1,(), Xiaohua Hou1   

  1. 1. Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2019-07-11 Published:2019-08-15
  • Corresponding author: Jun Song
  • About author:
    Corresponding author: Song Jun, Email:
引用本文:

覃弦, 李刚平, 杜凡, 宋军, 侯晓华. 与α葡萄糖苷酶抑制剂相关的肠气囊肿症1例并临床分析[J]. 中华胃肠内镜电子杂志, 2019, 06(03): 113-117.

Xian Qin, Gangping Li, Fan Du, Jun Song, Xiaohua Hou. Pneumatosis cystoides intestinalis associated with alpha-glucosidase inhibitors: a case report and clinical analysis[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2019, 06(03): 113-117.

目的

报道1例与a葡糖糖苷酶抑制剂(aGI)相关的肠气囊肿症(PCI),并探讨PCI的病因、发病率、症状及诊疗现状。

方法

患者,男,43岁,因"反复腹泻3年,加重半年"入院,既往患2型糖尿病,长期服用阿卡波糖。入院后经小肠增强CT、超声内镜(EUS)、结肠镜及病理活检被确诊为PCI。经停用阿卡波糖及内镜下圈套器切除较大隆起1月后复查,患者肠壁气囊肿基本消失,腹泻明显改善。本文搜集2007年至2018年国内外文献报道16例与aGI治疗相关的病例,对PCI及其诊治作出总结及分析。

结果

PCI通常为无症状的良性疾病,病因多样,发病率低。16例患者中,2例无症状、1例以胃肠道外症状就诊,其余均表现为腹痛、腹泻、腹胀、恶心、血便等非特异性消化道症状,依靠腹部CT、EUS、内镜活检等确诊,经保守治疗可治愈。

结论

患有与PCI相关的原发疾病者,需警惕伴发PCI可能,尤其服用αGI类降糖药的糖尿病患者,当出现腹痛、腹泻等胃肠道症状时,应常规行内镜、腹部CT等检查,必要时可给予内镜下治疗。

Objective

To report a case of Pneumatosis cystoides intestinalis associated with alpha-glucosidase inhibitors and to explore the etiology, incidence, symptoms, diagnosis and treatment of PCI.

Methods

A male patient aged 43 was admitted to our hospital due to "repeated diarrhea for 3 years and aggravated for half a year". He has been suffering from type 2 diabetes mellitus for 1 year and treated with acarbose. PCI was confirmed by enhanced CT, EUS, colonoscopy and pathological biopsy of the small intestine.After endoscopic resection of large bulges with a snare and the cessation of acarbose, the intestinal gas cysts disappeared and the patient′s symptoms improved. We collected 16 cases related to aGI treatment in the past 12 years intended to summarize the diagnosis and treatment methods of PCI.

Results

Among the 16 patients, 2 people were asymptomatic, 1 person with parenteral symptoms, and the rest presented non-specific gastrointestinal symptoms such as abdominal pain, diarrhea, abdominal distension, nausea, blood stool, etc. All patients were diagnosed by abdominal CT, EUS, endoscopic biopsy and cured by conservative treatments.

Conclusions

Patients with primary disease related to PCI should be aware of the possibility of PCI. Particularly, diabetic patients who under GI treatment should routinely undergo endoscopic and abdominal CT examinations when they have gastrointestinal symptoms such as abdominal pain and diarrhea, and endoscopic treatment could be given when necessary.

图1 小肠增强CT检查
图2 结肠镜及超声内镜检查
图3 病理诊断
表1 2007~2018年与αGI治疗有关的肠气囊肿症
序号 作者&年份 年龄&性别 αGI类药物&剂量&时间 主要症状 特殊检查 累及部位 治疗方法
1 Maeda等[10],2007 72女 伏格列波糖(0.9 mg/d)3年 腹痛 腹部平片&CT 不详 抗生素、机械通气
2 Saito等[11],2007 53女 伏格列波糖(0.6 mg/d) 1月 恶心、腹胀、颈部皮下气肿 腹部平片&CT 升结肠、降结肠 停αGI、氧疗,肠道休息
3 Tsujimoto等[6],2008 69男 伏格列波糖(0.6 mg/d) 1年8月 腹胀、便秘、直肠出血 腹部平片&CT;结肠镜; EUS 乙状结肠 停αGI、肠道休息
4 Vogel等[12],2009 65男 阿卡波糖(150 mg/d) 12年 左腹痛 腹部平片&CT;结肠镜; 病理活检 升结肠 停αGI、氧疗
5 Kojima等[13],2010 58男 米格列醇(150 mg/d) 1年 下腹痛、直肠出血 腹部CT; 结肠镜;病理活检 回盲部、升结肠 停αGI、肠道休息
6 Shimojima等[14],2011 48男 伏格列波糖2~4周 消化道外症状 胸部平片;腹部平片&CT 升结肠 停αGI、抗生素、肠道休息
7 Wu等[15],2011 67女 阿卡波糖 结肠镜 升结肠 停αGI
8 Tanabe等[16],2013 80女 不详 腹胀、腹痛 腹部平片&CT 小肠 停αGI、抗生素、肠道休息
9 Ogo等[17],2014 83 女 阿卡波糖(300 mg/d) 腹部平片&CT 升结肠、横结肠 停αGI、肠道休息
10 Rottenstreich等[18],2015 73男 阿卡波糖(150 mg/d)10年 呕吐、便秘 胸、腹部及骨盆平片、剖腹探查 回肠、升结肠 停αGI、抗生素
11 宗晔等[19],2016 67 男 阿卡波糖(150 mg/d)2年 腹胀 腹部盆腔CT;结肠镜 升结肠
12 Takase等[20],2017 78女 Voglibose(0.6 mg/d)2周 腹痛、腹泻、腹胀 腹部平片&CT 升结肠、横结肠 停αGI、肠道休息
13 吴利敏等[21],2017 71 男 阿卡波糖 腹泻 结肠镜、超声内镜;病理活检 降结肠、乙状结肠 停αGI、氧疗
14 胡梦成等[22],2017 72男 阿卡波糖(150 mg/d)10年 腹痛,血便 腹部CT;结肠镜;病理活检 降结肠、乙状结肠 停αGI、氧疗,肠道休息、益生菌
15 胡梦成等[22],2017 81 男 阿卡波糖(150 mg/d)3年 血便、腹胀 结肠镜;病理活检 乙状结肠 停αGI、肠道休息
16 Wang等[9],2018 72男 阿卡波糖 腹泻、粘液便,腹胀 腹部平片&CT;结肠镜(NBI) 升结肠、乙状结肠 停αGI、抗生素
17 本例 43 男 阿卡波糖(150 mg/d) 腹泻 小肠增强CT;结肠镜(NBI);超声内镜;病理活检 升结肠之外的大肠 停αGI、内镜治疗(圈套器切除)
[1]
Wu LL, Yang YS, Dou Y,et al. A systematic analysis of pneumatosis cystoids intestinalis[J]. World J Gastroenterol,2013,19(30): 4973-4978.
[2]
Morris MS, Gee AC, Cho SD,et al. Management and outcome of pneumatosis intestinalis[J]. Am J Surg,2008,195(5): 680-683.
[3]
Iida A, Naito H, Tsukahara K,et al. Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report[J]. J Med Case Rep,2017,11(1): 55-58.
[4]
王永娟,焦国慧,王玉明,等. 肠气囊肿症12例的诊治分析[J]. 中华消化内镜杂志,2017,34(2): 127-131.
[5]
Yale CE, Balish E.The natural course of Clostridium perfringens- induced pneumatosis cystoides intestinalis[J].J Med,1992, 23(3-4): 279-288.
[6]
Tsujimoto T, Shioyama E, Moriya K,et al. Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: A case report and review of the literature[J]. World J Gastroenterol,2008,14(39): 6087-6092.
[7]
Suzuki E, Kanno T, Hazama M,et al. Four Cases of Pneumatosis Cystoides Intestinalis Complicated by Connective Tissue Diseases[J]. Intern Med,2017,56(9): 1101-1106.
[8]
Wayne E, Ough M, Wu A,et al. Management Algorithm for Pneumatosis Intestinalis and Portal Venous Gas: Treatment and Outcome of 88 Consecutive Cases[J].J Gastrointest Surg, 2010, 14(3): 437-448.
[9]
Wang YJ, Wang YM, Zheng YM,et al. Pneumatosis cystoides intestinalis: six case reports and a review of the literature[J]. Bmc Gastroenterology,2018,18(1): 100-107.
[10]
Maeda Y, Inaba N, Aoyagi M,et al. Fulminant pneumatosis intestinalis in a patient with diabetes mellitus and minimal change nephrotic syndrome[J]. Intern Med,2007,46(1): 41-44.
[11]
Saito M, Tanikawa A, Nakasute K,et al.Additive contribution of multiple factors in the development of pneumatosis intestinalis: a case report and review of the literature[J].Clin Rheumatol,2007,26(4): 601-603.
[12]
Vogel Y, Buchner N J, Szpa kowski M,et al. Pneumatosis cystoides intestinalis of the ascending colon related to acarbose treatment: a case report[J]. J Med Case Rep,2009,3(1): 1-5.
[13]
Kojima K, Tsujimoto T, Fujii H,et al.Pneumatosis cystoides intestinalis induced by the α-glucosidase inhibitor miglitol[J].Intern Med,2010,49(15): 1545-1548.
[14]
Shimojima Y, Ishii W, Matsuda M,et al. Pneumatosis cystoides intestinalis in neuropsychiatric systemic lupus erythematosus with diabetes mellitus: case report and literature review[J].Mod Rheumatol,2011,21(4): 415-419.
[15]
Wu SS, Yen HH. Images in clinical medicine. Pneumatosis cystoides intestinalis[J].N Engl J Med,2011,365(8): e16.
[16]
Tanabe S, Shirakawa Y, Takehara Y,et al. Successfully treated pneumatosis cystoides intestinalis with pneumoperitoneum onset in a patient administered α-glucosidase inhibitor[J]. Acta Med Okayama,2013,67(2): 123-128.
[17]
Ogo A, Hasuzawa N, Sakaki Y,et al. Pneumatosis cystoides intestinalis related to α-glucosidase inhibitor treatment in a polymyalgia rheumatica patient with diabetes mellitus[J]. Diabetol Int, 2014,5(4): 244-248.
[18]
Rottenstreich A, Agmon Y, Elazary R. A Rare Case of Benign Pneumatosis Intestinalis with Portal Venous Gas and Pneumoperitoneum Induced by Acarbose[J].Intern Med,2015,54(14): 1733-1736.
[19]
宗晔,赵海英,王拥军,等. α-葡糖苷酶抑制剂诱导的结肠囊样积气症1例[J].胃肠病学,2016,21(10): 639-640.
[20]
Takase A, Akuzawa N, Naitoh H,et al. Pneumatosis intestinalis with a benign clinical course: a report of two cases[J]. BMC Res Notes,2017,10(1): 319-324.
[21]
吴利敏,林李淼,夏宣平,等. 肠气囊肿症1例报告[J]. 中国内镜杂志,2017, 23(10): 109-110.
[22]
胡梦成,张予蜀,洪嘉雯,等. 服用α-葡萄糖苷酶抑制剂相关的肠气囊肿症二例及文献分析[J]. 中华消化内镜杂志,2017,34(8): 592-594.
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