Chronic Diarrhea for 3 months Chief complaint Chronic

Chronic Diarrhea for 3 months § Chief complaint - Chronic diarrhea for 3 months § Present illness – 내원 3개월 전부터 지속된 수양성 설사 및 우하복부 통증으로 본원 소화기 내과 외래 방문 후 evaluation 위해 adm

Chronic Diarrhea for 3 months § Past History – DM/HTN/Pul. TB/Liver dz. (-/-/-/-) – 15년 전부터 흉통을 주소로 한약복용 중 § Social History – Alcohol: none – Smoking: none

Chronic Diarrhea for 3 months § Physical Exam – – – – Vital sign: BP 120/80, PR 88, RR 22, BT 36℃ General appearance: chronic ill appearance Mental state: Alert mentality Not pale conjunctiva, anicteric sclerae Oral cavity: Not dried tongue Neck: No palpable neck node Thorax : Symmetry expansion without deformity Clear breathing sound without rale Regular heart beat without murmur – Abdomen: Soft and flat Mild tenderness at Rt abdomen – Extremity: no pretibial pitting edema

Chronic Diarrhea for 3 months § Review of System General weight loss (-), fatigue (-), fever (-), chill (-) Skin skin rash (-), pigmentation (-), jaundice (-), itching (-) HEENT Headache (-), neck stiffness (-), diplopia (-), tinnitis (-), dry mouth (-) Respiratory dyspnea (-), DOE (-), cough/sputum/rhinorrhea (-/-/-), hemoptysis (-) Cardiac chest pain (-), palpitation (-), orthopnea (-), PND (-) GIT anorexia/nausea/vomiting/diarrhea/constipation(-/-/-/+/-), hematemesis(-), melena (-), hematochezia (-) Musculoskeletal pain(-), cramp(-), weakness(-), swelling(-) Urinary auria (-), oliguria (-), hematuria (-), dysuria (-) Neurology syncope(-), dizziness(-), weakness(-)

Chronic Diarrhea for 3 months

Abdominal X-ray

Colonoscopy

Barium enema

Abdominal CT

Chronic Diarrhea for 3 months § Colonoscopic biopsy – Chronic ulcer & chronic inflammation – capillary and vein의 vessel을 따라 심한 phlebosclerosis가 관찰 됨

Chronic Diarrhea for 3 months § Final diagnosis – Chronic ischemic colitis d/t phlebosclerosis § 보존적 치료 후 증상 호전 보여 퇴원 § 외래에서 추적 관찰 중

Mesenteric Phlebosclerosis § Phlebosclerotic colitis : Chronic ischemic colitis occurs as a result of venous obstruction due to phlebosclerosis § 1991년 일본에서 첫 증례보고 이후 현재까지 아시아권에서 21 예가 보고됨 § Calcification and fibrosis of superior mesenteric vein § Right side colon is commonly affected § Etiology and pathogenesis unknown § Chronic gradual disease progression

Mesenteric Phlebosclerosis J Chin Med Assoc 2007; 70(6); 227 -235

Mesenteric Phlebosclerosis § Tx : 금식 & TPN 등 보존적 치료 증상조절 안되거나 obstruction, perforation 등 합병증 발생 시 외과적 절제술 § Pathogenesis remain unclear but chronic ingestion of toxin or biochemical agents may have a part in the pathogenesis.