| Objective: In order to provide help for clinical diagnosis and differential diagnosis of benign intestinal ulcers,the etiology and clinical characteristics of the benign intestinal ulcers cases in recent 3 years in the Second Hospital of Dalian Medical University were retrospectively analyzed.Methods: The medical record retrieval system of the Second Hospital of Dalian Medical University was used to find the clinical materials of patients diagnosed with benign intestinal ulcers by colonoscope in the Second Hospital of Dalian Medical University from August,2014 to August,2017.108 patients were included,and the etiology,clinical manifestations,laboratory examinations,endoscopy and pathological results of the patients were retrospectively analyzed.Results: 1.A total of 108 cases of benign intestinal ulcers were collected.Benign intestinal ulcers was mostly caused by immune related diseases in 58patients(53.7%),include ulcerative colitis,Crohn's disease and Behect's disease;followed by vascular disease in 11 patients(10.2%),ischemic bowel diseases appears most frequently;Intestinal infectious disease in 8 patients(7.4%),include tuberculosis,virus infections and bacterial infections.Other rare causes in 9patients(8.4%),include anastomosic ulcer,drug-related ulcer,radiation enteritis and ulcers after electroresection of polyps;and the etiology of the rest 22 patients(20.3%)were not identified.2.The age range of patients in this study was 18-84 years old,and the average age was 48.54±1.632 years old.There were statistical differences among different etiology for patients' age distribution(P < 0.05).The variance analysis showed that the mean age of patients with immune related diseases and intestinal infectious diseases was significantly lower than that of vascular diseases and other rare causes.3.There were 55 male patients(50.9%)and 53 female patients(49.1%)in this study,male:female was 1.04:1.There was no significant difference for gender among the various etiologies of the benign intestinal ulcers in this study(P>0.05).4.The clinical manifestations were abdominal pain in 66 cases(61.1%),diarrhea in60 cases(55.6%),hematochezia in 60 cases(55.6%),body weight loss in 41 cases(13.0%),mucous or purulent bloody stool in 27 cases(25.0%),abdominal distensionin 23 cases(21.3%),extraintestinal manifestations in 19 cases(17.5%),fatigue in 14cases(13%),black stool in 11 cases(11.2%),constipation in 8 cases o(7.4%),fever in6 cases(5.6%),and night sweats in 5 cases(4.6%).There were differences for abdominal pain,mucous or purulent bloody stool,diarrhea,hematochezia and extraintestinal manifestations among the various etiologies of benign intestinal ulcers(P < 0.05),and all of them were most common in immune related diseases.5.Laboratory examinations showed that the occult blood test was positive in54 cases(50.0%),inflammatory bowel disease antibody was positive in 38 cases(35.2%),anemia in 37 cases(34.3%),and hypoalbuminemia in 33 cases(30.6%),all of them were most common in ulcerative colonitis.6.According to the number of ulcers,10 cases(9.3%)were single and 98 cases(90.7%)were multiple,the multiple ulcer was more common.In terms of the distribution of ulcers,benign intestinal ulcers could accumulate all the parts of the intestine.7.Complications: gastrointestinal hemorrhage in 54 cases(50%),among which ulcerative colitis was the most common(57.4%).Intestinal stenosis in 6 cases(5.6%),among which Crohn's disease was the most common(83.3%).8.Most pathological findings were not specific,which included that Chronic inflammatory reaction in 73 cases(67.6%);inflammatory cell aggregation in 46 cases(42.6%);cryptitis/crypt abscess in 39 cases(36.1%),among which 31 cases(79.5%)were ulcerative colitis;glandular distortion / deformation /structural destruction in 27 cases(25.0%);coincidence ulcer formation in 24 cases(22.2%);Inflammation with haemorrhage and hyperemia in 7 cases(6.5%);granuloma in 3 cases(2.8%),all of which were in Crohn's disease;fissuring ulcers in2 cases(1.9%),all of which were in Crohn's disease.Only 5 cases had relatively specific pathological findings(all were found in Crohn's disease).Conclusion: 1.The etiology of benign intestinal ulcers are complex,the most common etiology are immune related diseases,including ulcerative colitis,Crohn's disease and Behect's disease;followed by vascular diseases,in which ischemic bowel disease is the most common;the third is intestinal infectious disease,including tuberculosis,virus infections and bacterial infections.2.Except that abdominal pain,mucous or purulent bloody stool,diarrhea,hematochezia,and extraintestinal manifestations are the most common in immune related diseases,other clinicalmanifestations of benign intestinal ulcers are not specific.3.The mean age of immune related diseases and intestinal infectious diseases was significantly lower than vascular diseases and other rare causes in patients with benign intestinal ulcers,but there was no difference for gender among the various etiologies.4.Laboratory examinations in patients with benign intestinal ulcers are non-specific.Positive occult blood test,positive inflammatory bowel disease antibody,anemia and hypoalbuminemia are common in ulcerative colonitis.5.Under endoscopy,multiple ulcer is common and the ulcer can accumulate in various parts of the intestine.Gastrointestinal hemorrhage is more common in ulcerative colitis and intestinal stenosis in Crohn's disease.6.The pathological specificity is poor for benign intestinal ulcers,most benign ulcers only indicate different degree of inflammatory cell infiltration or chronic inflammation,and the clinical value is limited... |
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