Diabetic ketoacidosis complicated with acute necrotizing enteritis: a case report and literature review
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摘要: 本文介绍1例青少年糖尿病酮症酸中毒合并急性坏死性肠炎的诊治过程。该青少年患者以意识障碍、休克就诊，入院初期考虑糖尿病酮症酸中毒，经积极补液、降糖等对症治疗，意识水平改善、休克难以纠正。病程中患者渐起腹痛，完善腹部CT、全主动脉CTA、肠系膜血管CTA等影像学检查考虑急性坏死性肠炎，经过我院MDT讨论，在积极抗休克同时，予以加强抗感染、抑酸抑酶、灌肠、芒硝外敷、维持酸碱水电解质平衡等对症支持治疗，患者病情明显改善，最终避免了外科手术，治愈出院。糖尿病是急性坏死性肠炎的危险因素，对糖尿病酮症酸中毒合并急腹症患者应高度警惕，早期发现影像学中肠壁水肿和积气等特征性表现，提供最佳治疗方案，降低患者病死率。Abstract: The article introduced the diagnosis and treatment of a case of adolescent diabetes ketoacidosis with acute necrotizing enteritis. The young patient was treated for consciousness disorder and shock. At the initial stage of admission, diabetes ketoacidosis was considered. After early fluid resuscitation, blood glucose control and other symptomatic treatment, the consciousness level of the patient was improved but the shock was difficult to correct. Meanwhile the patient gradually developed abdominal pain. Abdominal CT, total aortic CTA, mesenteric vascular CTA and other imaging examinations indicated the patient has acute necrotizing enteritis. After MDT in our hospital, we adjusted the treatment plan, such as strengthening anti infection, acid inhibition, enzyme inhibition, enema, mirabilite external application, and maintaining homeostasis.The patient's condition improved significantly, and finally avoided surgery, cured and discharged. Diabetes is a risk factor of acute necrotizing enteritis, thus diabetes ketoacidosis patients with acute abdomen should be highly vigilant to this disease.Early detection of imaging features such as intestinal wall edema and gas accumulation, and provide the best treatment plan can reduce the mortality rate of patient.
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Key words:
- diabetic ketoacidosis /
- acute necrotizing enteritis /
- case report /
- literature review
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表 1 急性坏死性肠炎文献总结
序号 作者/发表时间 性别 年龄/岁 病因 腹部影像学 治疗方案 病变部位 预后 1 Watson/1991[23] 男 44 糖尿病，酗酒 肠管扩张、水肿 药物+手术 空肠和回肠 好转 2 Clarke/1994[24] 女 53 无 小肠梗阻、腹腔积液 药物+手术 回肠 好转 3 乔骋/1996[25] 男 40 烧伤 腹腔积液 手术 空肠 好转 4 Farrant/1996[26] 女 43 长期素食 未提及 未提及 回肠末端和盲肠 好转 5 Gui/2002[9] 女 66 糖尿病，高血压 未提及 未提及 空肠和回肠 死亡 6 孙蕾民/2003[27] 女 40 溃疡性结肠炎 腹腔积液(血性) 手术 结肠 好转 7 Yamaguchi/2003[28] 男 63 糖尿病肾病，脑梗死 乙状结肠水肿 手术 乙状结肠 好转 8 Matsuda/2007[18] 男 50 糖尿病，高脂血症 小肠梗阻、腹腔积液 手术 空肠 好转 9 杨岩/2013[29] 女 49 宫颈癌，依立替康化疗 小肠梗阻、腹腔积液 药物+手术 小肠 好转 10 姜元/2015[30] 男 39 长期酗酒 肠壁积气、肝门静脉积气 / / 入院1 h突发呼吸心跳骤停，抢救无效死亡 11 赵孝开/2018[31] 男 46 烧伤 肠壁水肿、腹腔积液 药物+手术 小肠 好转 12 姚敬梓/2021[32] 男 81 不洁饮食 腹腔游离气体 手术 小肠 好转 13 蒋龙/2021[33] 男 47 重症胰腺炎 肠梗阻、肠壁积气 手术 回肠、右半结肠 死亡 14 Zeng/2021[34] 男 51 高血压、痛风 肠壁水肿 手术 空肠和回肠 死亡 15 佟印妮/2021[35] 女 73 糖尿病、高血压 肠壁水肿、肝门静脉积气 药物 小肠 好转 16 本病例 男 16 糖尿病 肠梗阻、肠壁水肿积气 药物 小肠和右半结肠 好转 
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