硬皮症病人併發假性腸阻塞

“Hide-bound” bowel sign in a patient with progressive systemic sclerosis and chronic intestinal pseudo-obstruction

A 69-year-old woman presented with severe abdominal pain and distension for 2 days. She is a patient with limited type progressive systemic sclerosis. She had experienced the same episodes in the past few months. Physical examination demonstrated Raynaud’s phenomenon, sclerodactyly, skin tightness on face, hands and forearms, polygonal telangiectasis on face and hands, soft and distended abdomen with diffuse tenderness, decreased bowel sounds and tympany to percussion. There were no signs of mechanical intestinal obstruction or peritonitis. The plain film of the abdomen demonstrated severe dilated loops of small bowel, termed the “hide-bound” bowel sign. This sign delineates narrow separation and normal thickness of valvulae conniventes, relative to dilatation of the bowel lumen. It was thought to be caused by more severe smooth muscle atrophy and fibrosis of the inner circular layer of the tunica muscularis, than the outer longitudinal layer [1]. She was diagnosed with chronic intestinal pseudo-obstruction based on clinical course, physical examination and radiographic findings, and treated conservatively with parenteral nutrition, cisapride and antibiotics.