증 례 : 혈액투석 환자에서 급성 대장염의 합병증으로 발생한 소장-대장 누공 1예 = Case Reports : Enterocolic Fistula caused by Acute Colitis in a Hemodialysis Patient

국문 초록 (Abstract)

전신 상태가 불량한 성인 혈액투석 환자에서 위막성 대장염으로 추정되는 급성 대장염 발생시, 적절한 치료에도 불구하고 설사 등의 임상증세가 지속되는 경우에는 드문 합병증이지만 소장-대장 누공 발생 가능성을 고려해야 할 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Enterocolic fistulas are commonly associated with previous surgery, Crohn’s disease, diverticulitis, radiation therapy, and malignancy. Here, we report a rare case of enterocolic fistula caused by acute colitis in a hemodialysis patient. A 62-year-old man on maintenance hemodialysis underwent a radical nephrectomy via a paramedian incision due to spontaneous right kidney rupture and was treated with prophylactic antibiotics. On the 16th day of antibiotic therapy, he complained of abdominal pain and diarrhea. Abdominal computed tomography (CT) and ascitic fluid culture revealed acute bacterial peritonitis and sigmoidoscopy showed acute colitis. After treating these diseases with adequate antibiotics, the abdominal pain and ascites were relieved, but the diarrhea persisted. Abdominal CT obtained 7 days later showed an enterocolic fistula. To our knowledge, this is the first case of enterocolic fistula due to acute colitis in Korea. (Korean J Med 2016;90:41-45)

참고문헌 (Reference)

1 Falconi M, "The relevance of gastrointestinal fistulae in clinical practice : a review" 49 (49): 2-10, 2002

2 Gore, Richard M., "Textbook of gastrointestinal radiology" Saunders 2015

3 Surawicz CM, "Pseudomembranous colitis :causes and cures" 60 : 91-100, 1999

4 Machiels F, "Enterocolonic fistula, a rare complication of necrotizing enterocolitis" 79 : 260-261, 1996

5 Paley RH, "Enterocolonic fistula as a late complication of necrotizing enterocolitis" 132 : 989-990, 1979

6 Levin TL, "Enteric fistula formation secondary to necrotizing enterocolitis" 21 : 309-311, 1991

7 Kiely E, "Colonic stricture and enterocolic fistulae following necrotizing enterocolitis" 71 : 613-, 1984

8 Abcarian H, "Coloenteric fistulas" 21 : 281-286, 1978

9 변태준, "Clostridium difficile-Associated Disease (CDAD)의 최근 임상양상의 변화" 대한소화기학회 54 (54): 13-19, 2009