THIẾU MÁU VI MẠCH ĐẠI TRÀNG: CÁC YẾU TỐ NGUY CƠ, THAY ĐỔI GIẢI PHẪU MẠCH MÁU ĐẠI TRÀNG, ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ VIÊM ĐẠI TRÀNG THIẾU MÁU. CA LÂM SÀNG VÀ ĐIỂM LẠI Y VĂN

Abstract

The aims of study: 1. Evaluation the clinic, paraclinic features and surgical management of ischemic colitis patient (case report). 2. Evaluation of risk factors and literature review. Patient and method: Retrospective study (case report). Result: Female patient, aged of 83 year olds. Medical history: Hypertension and diabetes mellitus. Hospitalization for abdominal pain and lower gastrointestinal bleeding (hematocheria). Physical examination: No palpable mass, pain in left lower abdomen with tenderness, Digital exammination: bright blood stool. Abdominal CTscanner revealed segmental sigmoid thickening and pericolic stranding. Colonoscopy: Stricture and. circumferential ulcer of sigmoid colon, edematous and fragile mucosa, segmental erythema (sigmoid colon) and mucosa bleeding... + Laboratory test: Red blood cell count 4,03 T/L; Hemoglobine 119 g/L; Hematocrite 0,36 L/L; White cell count 13,11 G/L;  Platelete count 303 G/L; Fibrinogen 7,31 g/L; Prothrombin 116%; Glucose 8,33 mmol/L; Creatinin 98 mmol/L, Ure 3,86 mmol/L; Albumin 38,1 g/L; GOT 18,76 U/L; GPT 15,1 U/L, CEA 1,16 ng/ml. + Intraoperative findings: Intraabdominal fluid, sigmoid thickening wall and stricture. + Operation perfomed: Sigmoid segmentectomy with side to end anastomosis. + Histopathologic findings: Stricture, inflammatory and ulcer of colon with scattered necrosis. - Conclusion: Ischemic colitis could occur in patients greater than 60 -70 year olds. Risk factors associated with ischemic colitis are cardiovascular diseases, atherosclerosis, atrial fibrillation, hypertension, diabetes mellitus, constipation, chronic kidney disease, aortic aneurysm repaire or certain medications such as non-steroidal anti-inflammatoru drugs (NSAIDs), oestrogen therapy and also hypotension... Clinical symptoms are vague and nonspecific consisting of abdominal pain, lower abdominal tendeness, lower gastrointestinal bleeding, diarrhea. Cross sectional CT is the best judged transmural involvement (the depth of inflammation) as  colonoscopy alone cannot reliably confirm or exclude transmural lesion. Medical management is indicated for moderated case consisting of intravenous resuscitation, blood glucose control, bowel rest (fasting, nasogastric tube placement) and intravenous antibiotic. Surgical management indicated for perforation or stricture of colon and patients with peritoneal signes (Type II). The postoperative mortality rate is elevated to 48-54% for peritonitis of colonic perforation.