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重症胰腺炎累及结肠虽不多见,但却是致命的。其病变包括结肠局部麻痹、胰腺炎性肿块压迫结肠引起梗阻、胰腺炎后结肠狭窄、结肠瘘,以及结肠坏死。本文报道作者处理10例重症胰腺炎并发肠穿孔及坏死的经验。10例结肠病变中7例是在胰腺手术或剖腹探查中获得诊断,另3例在术后4～19天发现,该3例中的1例出现持续腹腔脓毒症,另2例引流液中出现粪汁。病变累及横结肠3例;脾曲结肠4例;同时累及脾曲和降结肠1例;升结肠1例;接近全结肠1例。全部病人接受了病变结肠切除及近端结肠或回肠造瘘术。4例切除的结肠标本显示为缺血性损害,其程度从早期粘膜坏死、上皮细胞坏死脱落、肠壁固有层水肿及充血,直至严重的全层肠壁梗塞坏死。本组患者的结肠坏死病变很可能是从肠壁内侧向外侧发展的。10例中的另6例结肠未见缺血损害,其中4例有结肠穿孔,该4例中的2例分别为先天性或后天性憩室穿孔,标本提示继发于急性胰腺炎的肠壁外炎症导致穿孔;6例中另2例接近正常的结肠粘膜突然变成穿孔、边缘充血的肉芽
Severe pancreatitis involving the colon is rare, but it is fatal. The lesions include colon partial paralysis, colon obstruction caused by pancreatic inflammatory mass oppression, colon stenosis after pancreatitis, colonic fistula, and colonic necrosis. This article reports the authors’ experience in treating 10 cases of severe pancreatitis complicated with intestinal perforation and necrosis. Seven of 10 cases of colonic lesions were diagnosed during pancreatectomy or laparotomy and the other 3 cases were found 4 to 19 days after surgery. One of the three cases developed persistent abdominal sepsis and the other two cases of drainage Feces appear. Lesions involving the transverse colon in 3 cases; splenic colon in 4 cases; involving both splenic and descending colon in 1 case; ascending colon in 1 case; close to the whole colon in 1 case. All patients underwent colostomy and proximal colon or ileostomy. Four resected colon specimens showed ischemic lesions ranging from early mucosal necrosis, epithelial cell necrosis, edema and hyperemia in the lamina propria until severe full-thickness intestinal infarction necrosis. Colonic necrosis in this group of patients is likely to develop from the medial to the gut wall. In the other 6 cases of 10 cases, there was no ischemic injury in the colon, of which 4 cases had colonic perforation. The 2 cases in 4 cases were congenital or acquired diverticulum perforation respectively. Specimens were found to be secondary to the intestinal wall of acute pancreatitis Inflammation led to perforation; in the other 2 cases of 6 cases, the normal colonic mucosa suddenly became punctured and marginally congested granulation