A few days ago, I just went to work. A head nurse in this hospital took her relatives and a mother and son to see me for a doctor. His son seemed to be a filial son. When he saw me, he said loudly: "Doctor, my mother last night She had a lot of blood, you must help her look up! I hurriedly told them to sit down and ask for a detailed medical history. The old man is 68 years old this year and has a history of high blood pressure for more than 20 years. Last night, he had stomach pain, diarrhea, and then blood in the stool. Dark red, with a appearance of more than ten milliliters, without mucus, pus and blood. The patient and son are very nervous because they have never had blood in the stool. I have no signs of peritoneal irritation, and my vital signs are stable. There is no obvious bleeding under anoscope.
Under anoscopy, the rectal mucosa is smooth, no erosive ulcers, no obvious active bleeding, and one degree of internal hemorrhoids
The elderly, with a history of hypertension, abdominal pain, diarrhea, transient blood in the stool, and no bleeding in the lower rectum, I have a spectrum in my heart, and I will explain to the patient that I should have an enteroscope first.
The colonoscopy result came out the next day, showing ischemic enteritis
When the patient showed me the results, I was just too busy, and told him to prescribe some medicine. After a while, the patient’s son took the medicine and rushed into my consulting room and said: Doctor, are you crazy, my mother is bleeding, and you still prescribe blood-activating medicine for her? "I told him to stay safe and not restless, and explain the condition to him after I see the patient.
The patient had ischemic enteritis. It was because the blood vessels supplying the intestinal mucosa were blocked, which made the intestinal mucosa insufficiently supplied with blood. The intestinal mucosa suffered from erosion and caused bleeding. The treatment needed to dredge the blood vessels, so I prescribed Xueshuantong capsules for his mother. If we use hemostatic drugs to make the blood sticky, it will be counterproductive. The more you stop the bleeding, the more bleeding. And his mother is a typical patient:
Ischemic enteritis is more common in people over 50 years old with a history of hypertension.
The typical symptoms are abdominal pain, diarrhea, and transient blood in the stool.
Colonoscopy is characterized by superficial erosions and ulcers parallel to the longitudinal axis of the intestine, generally single
Superficial ulcers and erosions of the sigmoid colon parallel to the longitudinal axis of the intestinal cavity.
Tell his mother that it is a mild patient. Erosion only accounts for one-fifth of the intestinal cavity. Don't be too nervous. A very small number of patients will have intestinal necrosis and peritonitis. Colonoscopy is contraindicated and angiography should be performed in time. Confirmed and transferred to surgery.
After listening to my explanation, the patient’s son was convinced and went back.
Today, the patient came for a follow-up visit, and there was no blood in the stool. She was instructed to use Xueshuantong Capsule for another week to consolidate the treatment and control her blood pressure. The patient went back gratefully.
In outpatient clinics, ischemic enteritis is a common disease, but it is also a disease with a high rate of misdiagnosis and mistreatment. To reduce its misdiagnosis and mistreatment rate is also the original intention of my writing this article.