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男患,38岁。因低热1周,上腹痛1天伴呕宿食,解柏油便1次入院。实验室:尿蛋白（+）,RBC少许,血WBC15×10~9/L、N 86%、Hb13.5g/L,肝、肾功能正常。经止血剂及胃肠减压治疗无缓解。入院第6天,突解暗红色血便1500g,伴上腹痛及上腹部肌紧张、压痛、反跳痛。急诊胃镜:十二指肠球下壁见1.0×0.9cm溃疡,周边粘膜大范围充血、水肿,多个片状出血灶。幽门不全梗阻。外科急诊手术。术中发现:“十二指肠溃疡出血,距曲氏韧带15cm处有50～60cm空肠坏死,余空肠及回肠有4～5处肠段肌浆层出血。予以缝扎,行胃大部切除,胃空肠吻合术,空肠切除术”。术后仍解黑色稀便2～3次/天,术后第3天,面部及双下肢出现紫癜,大小不等,对称分布,压之不退,部分呈出血性丘疹状。膝关节红肿、痛、活动受限。并出现尿
Male suffering, 38 years old. 1 week due to fever, abdominal pain 1 day with vomiting, feeding, solution of asphalt 1 admission. Laboratory: Urinary protein (+), RBC a little, blood WBC15 × 10 ~ 9 / L, N 86%, Hb13.5g / L, liver and kidney function is normal. Hemostatic agents and gastrointestinal decompression without remission. On the sixth day of admission, sudden dark red bloody stool 1500g, accompanied by abdominal pain and upper abdominal muscle tension, tenderness, rebound tenderness. Emergency gastroscopy: see 1.0 × 0.9cm ulcers on the wall of duodenal bulb, a large area around the mucosa congestion, edema, multiple flaky hemorrhage. Pylorus incomplete obstruction. Surgical emergency surgery. Intraoperative findings: “Duodenal ulcer hemorrhage, 15cm away from the Quti’s ligament at 50 ~ 60cm jejunal necrosis, more than the jejunum and ileum with 4 to 5 intestinal sarcocytic hemorrhage. To be sutured, line subtotal gastrectomy , Gastrojejunostomy, jejunum resection ”. After surgery still black loose stool 2 to 3 times / day, 3 days after surgery, the face and lower extremities appear purpura, size, symmetrical distribution, the pressure of retreat, some hemorrhagic papules. Knee swelling, pain, limited activity. And urine