Abdominal radiograph with intravesical air and possible small bowel atresia.
Abdominal radiograph with intravesical air and possible small bowel atresia.
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腹部 X 光片显示膀胱内空气，可能有小肠闭锁。
DOI：
10.1016/j.jpeds.2013.12.017
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Wright,ClydeJ
中科院分区：
文献类型：
--
作者：
Stewart,MichaelS;Dietz,RobertM;Landman,MatthewP;Moulton,StevenL;Wright,ClydeJ
一名孕35周的男婴因母体子痫前期而出生，根据19周胎儿超声和确认性胎儿磁共振成像，产前诊断为Eagle-Barrett或prune belly综合征（PBS）。产前过程中羊水过多需要治疗性羊膜穿刺术和巨囊需要膀胱穿刺术。婴儿通过剖宫产出生，羊水中有粪染色，呼吸系统受损，需要在产房插管。体格检查显示胸径和胸形正常，腹部扩张，肌肉松弛。出生第5天，患者出现明显腹胀和胃管胆汁引流。腹部x线片（图1）显示胃和十二指肠近端有空气，远端气体缺乏。有明显的膀胱扩张，概述了偶然引入的空气从导尿管放置。造影剂灌肠(图2；可在www。jpeds。Com)显示微结肠与小肠闭锁有关。随后剖腹探查发现膀胱大幅扩张，肠完全通畅伴胎便密集，后肠旋转不良，提示大囊性小结肠肠蠕动不足综合征（MMIHS）。使用3毫升注射器和30号针头将高渗透性水溶性造影剂直接注入小肠管腔，软化浓缩的胎便，使其被挤进大肠，然后从下面排出。
A male infant of 35 weeks’ gestational age was born due to maternal preeclampsia with a prenatal diagnosis of Eagle-Barrett or prune belly syndrome (PBS) based on 19-week fetal ultrasound and confirmatory fetal magnetic resonance imaging. The antenatal course was complicated by polyhydramnios requiring a therapeutic amniocentesis and megacystis requiring vesicocentesis. The infant was born via cesarean delivery with meconium-stained amniotic fluid and had respiratory compromise necessitating intubation in the delivery room. Physical examination was noteworthy for a normal thoracic diameter and shape with abdominal dilation and laxity of musculature. On day of life 5, he developed significant abdominal distention and bilious drainage from his orogastric tube. An abdominal radiograph (Figure 1) showed air in the stomach and proximal duodenum with a paucity of distal gas. There was marked dilation of the bladder, outlined by incidental introduction of air from urinary catheter placement. A contrast enema (Figure 2; available at www. jpeds. com) was performed showing a microcolon concerning for small bowel atresia. Subsequent exploratory laparotomy revealed a massively dilated bladder, complete bowel patency with inspissated meconium, and hindgut malrotation, suggestive of megacystismicrocolon intestinal hypoperistalsis syndrome (MMIHS). Direct injection of a hyperosmotic, water-soluble contrast material into the lumen of the small bowel using a 3-mL syringe and 30-gauge needle softened the inspissated meconium, allowing it to be milked into the large bowel and later passed from below.