中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (3): 210-214.

• 论著 • 上一篇    下一篇

儿童隐源性多灶性溃疡性狭窄性小肠炎1例并文献复习

张萍1,孙桦1,张烨1,吴婕1,王玉环1,姜支农2,黄瑛1   

  1. 1 复旦大学附属儿科医院消化科 上海,201102;2 浙江大学医学院附属邵逸夫医院病理科 杭州,310016
  • 收稿日期:2018-07-31 修回日期:2018-06-25 出版日期:2018-06-24 发布日期:2018-06-25
  • 通讯作者: 黄瑛

Anaemia and melaena due to cryptogenic multifocal ulcerating stenosing enteritis: case report and review of literature

ZHANG Ping1, SUN Hua1, ZHANG Ye1, WU Jie1, WANG Yu-huan1, JIANG Zhi-nong2, HUANG Ying1   

  1. 1 Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai 201102, China; 2 Department of Pathology, Shao Yifu Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
  • Received:2018-07-31 Revised:2018-06-25 Online:2018-06-24 Published:2018-06-25
  • Contact: HUANG Ying

摘要: 目的:报道1例儿童隐源性多灶性溃疡性狭窄性小肠炎(CMUSE)的临床特点,提高对该罕见病的认识。方法:总结1例儿童CMUSE的临床特点、实验室检查、影像学检查及内镜下表现、病理特征和诊疗经过。并行文献复习,总结CMUSE的临床表现及预后。 结果:男,9岁6个月,因“反复贫血伴黑便6年”就诊。患儿3岁多出现口唇苍白,以“缺铁性贫血”治疗效果欠佳,后相继出现反复柏油样便和腹痛,住院查炎症指标正常,胃镜和结肠镜检查未见异常,胶囊内镜示小肠多发环形狭窄伴溃疡,组织病理学未见特异性表现,诊断为CMUSE。予强的松龙和硫唑嘌呤口服,复查胶囊内镜,病变明显好转。目前随访8个月,患儿无复发。文献复习发现CMUSE好发于中青年,18~50岁占68.6%(35/51)。就诊前平均病程9.9年。CMUSE发病早期以腹痛(67.9%)、贫血(32.1%)和消化道出血(18.5%)为主要表现。胶囊内镜滞留率37.9%,再手术率29.7%。结论:不明原因的反复黑便、贫血伴发小肠溃疡和狭窄性病变时需考虑CMUSE。内镜检查的诊断价值较高。糖皮质激素治疗有效,但易复发,预后欠佳。

Abstract: Objective:To report a case of cryptogenic multifocal ulcerating stenosing enteritis (CMUSE), and to improve the cognition of this rare disease. Methods:Clinical characteristics, laboratory examination, imaging examination, endoscopic findings, pathological features and treatment of the patient with CMUSE from Children's Hospital of Fudan University were collected. The related literature was searched from Wanfang Data Service Platform, Chinese Biomedical Database, PubMed and EMBASE (up to June 2018) by using search terms ("cryptogenic multifocal ulcerating stenosing enteritis" OR CMUSE OR "cryptogenic, multifocal, ulcerous, and stenosing enteritis"). Results:We reported a male child who presented with repeated anaemia and melaena for more than 6 years. Capsule endoscopy of multifocal ulcerating stenosing and pathological features were compatible with CMUSE. Systemic corticosteroid was initiated at 2 mg·kg-1·d-1. The side effects of systemic corticosteroid about visual ambiguity were observed after one month. Then, the steroid was weaned, and azathioprine was initiated at 1 mg·kg-1·d-1 as a steroid-sparing agent. After following for 8 months, the patient was in the remission without anaemia, melaena and abdominal pain. According to literature, 68.6% of cases had an onset in youth and middle-age adults, and the main clinical manifestations were abdominal pain (67.9%), anaemia (32.1%) and gastrointestinal bleeding (18.5%). Capsule endoscopy had a risk retention rate of 37.9%, and the recurrence rate was high with the reoperation rate of 29.7%. Conclusion:The diagnosis of CMUSE should be considered in patients with unexplained recurrent melaena, anemia and small intestinal ulcers and stenosis. Endoscopy plays a vital role in the diagnosis. Glucocorticoid is effective, but easy to relapse.