Intestinal Involvement in Kawasaki Disease
Intestinal Involvement in Kawasaki Disease
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DOI：
10.1016/j.jpeds.2018.06.034
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发表时间：
2018-11-01
影响因子：
5.1
通讯作者：
Cascio, Antonio
中科院分区：
文献类型：
--
作者：
Colomba, Claudia;La Placa, Simona;Cascio, Antonio
目的描述一个川崎病肠道受累的病例，并分析其他已发表的报告，以确定川崎病胃肠道受累的临床特征，诊断问题和治疗方法。如果一篇文章报告了川崎病肠道受累患者的数据，则认为该文章有资格纳入系统综述。结果共纳入33篇文献，共48例川崎肠道受累病例。发热、腹痛和呕吐是观察到的最常见症状，所有病例在肠道主诉后均出现典型的川崎体征和症状。平片、超音波及电脑断层显示假性肠梗阻为最常见的胃肠道受累征象; 25位病患接受手术治疗。21例病例记录了心脏受累。除三名患者外，所有患者均接受了静脉注射免疫球蛋白或阿司匹林的药物治疗。28例患者预后良好，7例患者冠状动脉持续异常，1例患者出现紫绀，随后出现左手和前足坏疽，3例患者死亡。结论在川崎的特征性临床特征出现之前出现肠道症状可能会延误川崎的诊断和治疗。从而增加心脏并发症的风险。此外，患者可能会经历不必要的侵入性手术。因此，儿科医生和小儿外科医生。在诊断有发热、腹部症状和放射学检查发现假性梗阻的儿童时，应考虑川崎病。
Objectives To describe a case of Kawasaki disease with intestinal involvement and to analyze other published reports to define clinical characteristics, diagnostic issues, and therapeutic approaches of gastrointestinal involvement in Kawasaki disease.Study design A computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patient(s) with intestinal involvement in Kawasaki disease. Our case was also included in the analysis.Results Thirty-three articles reporting 48 cases of Kawasaki disease with intestinal involvement were considered. Fever, abdominal pain, and vomiting were the most frequent symptoms observed and typical Kawasaki disease signs and symptoms appeared after intestinal complaints in all cases. Plain radiographs, ultrasonography, and computed tomography showed pseudo-obstruction as the most frequent sign of gastrointestinal involvement; 25 patients underwent surgery. Cardiac involvement was documented in 21 cases. All but three patients received medical treatment with immunoglobulin intravenous or aspirin. The outcome was good in 28 patients; 7 patients showed persistence of coronary artery abnormalities; 1 patient developed cyanosis, and later, left hand and forefoot gangrene: 3 patients died.Conclusions The diagnosis and treatment of Kawasaki disease might be delayed if intestinal symptoms appear before the characteristic clinical features of Kawasaki disease. thus, increasing the risk of cardiac complications. Furthermore, patients may undergo unnecessary invasive procedures. Pediatricians and pediatric surgeons, therefore. should consider Kawasaki disease among diagnoses in children with fever, abdominal symptoms, and radiologic findings of pseudo-obstruction.