Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants
Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants
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DOI：
10.1080/08035250600617123
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发表时间：
2006-11-01
期刊：
影响因子：
3.8
通讯作者：
Tomita, Ryouichi
中科院分区：
文献类型：
--
作者：
Koshinaga, Tsugumichi;Gotoh, Hiroshi;Tomita, Ryouichi
目的：阐明极低出生体重儿（VLBW）自发性局限性肠穿孔（SLIP）与肠道形态学特征（如扩张）的关系。研究方法：回顾性分析1983 ~ 2003年间13例因SLIP而接受剖腹手术的VLBW婴儿（< 1500 g）的病历。分析其临床表现，包括母源性、产前及围生期因素，并比较剖腹手术与临床表现。结果如下：出生后病理状况包括动脉导管未闭（n=7）、败血症（n=2）、呼吸窘迫综合征（n=7）、脑室内出血（n=2）、经脐静脉留置导管（n=1）和肺炎（n=1）。对7例动脉导管未闭患儿应用消炎痛治疗，对1例支气管肺发育不良患儿应用地塞米松预防治疗。手术结果显示回肠局部小穿孔。5例患者有肠扩张：2例在扩张的肠中部穿孔，3例在扩张区域近端穿孔。结论：本研究发现穿孔与肠扩张之间无明显关系。当循环衰竭变得严重时，穿孔可发生在缺血肠的任何部分，并且不一定限于扩张的肠。我们认为，SLIP和肠道扩张可能发生在相同的基础上，在低出生体重儿，但疾病的过程可能是不同的病因。
Aim: To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very-low-birthweight (VLBW) infants. Methods: The medical records of 13 VLBW infants (< 1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared. Results: Postnatal pathological conditions included patent ductus arteriosus (n=7), sepsis (n=2), respiratory distress syndrome (n=7), intraventricular haemorrhage (n=2), an indwelling catheter via the umbilical vein (n=1) and pneumonia (n=1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched-out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients.Conclusion: This study found no significant relationship between perforation and dilatation of the intestine. Perforation may occur in any portion of the ischaemic intestine when circulatory failure becomes severe, and is not necessarily restricted to the dilated intestine. We believe that SLIP and intestinal dilatation may occur on the same basis in low-birthweight infants; however, the disease process may be aetiologically different.