Segmental ileal dilatation in a child.
Segmental ileal dilatation in a child.
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儿童节段性回肠扩张。
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Cenita J. Sam
中科院分区：
文献类型：
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作者：
Cenita J. Sam
手术探查无病理症状或特征性影像学发现。腹部x线片通常无相关性，但在非常罕见的肠梗阻患者中，可能由于囊肿或肠系膜扭转压迫邻近的肠道，可见肠袢扩张伴气液水平。腹部超声检查可提示诊断，腹部超声检查可显示与肠袢有关的囊性病变，远离邻近脏器。据报道，这些囊肿的特征性发现是由于乳糜的高液面和较重的淋巴引起的低液面CT扫描显示病变的液体衰减及其与邻近脏器的关系。一个特征性的乳糜-淋巴液水平也被描述过然而，在本系列中，尽管超声和CT扫描能够在十二指肠-空肠屈曲区发现囊性病变，远离邻近脏器，但乳糜淋巴囊肿的明确术前诊断无法做出。这些囊肿的治疗包括切除邻近的肠，也可能不包括切除。大多数囊肿可以去核（如第1例）；然而，在某些情况下，如果不牺牲邻近肠道的血液供应，这是不可能的，因此需要切除（如第二例患者）。手术如有袋化和引流与高复发率相关（如第二例），最好避免切除标本的组织病理学显示单房或多房囊肿囊肿通常内衬单层内皮，可能含有淋巴组织和泡沫细胞4,10
surgical exploration as there are no pathognomonic symptoms or characteristic imaging findings. Abdominal radiographs are usually non contributory, however may reveal dilated bowel loops with air-fluid levels in the very rare patients with intestinal obstruction which may result from compression of the adjacent bowel by the cyst6 or by mesenteric volvulus. The diagnosis may be suggested by an ultrasound of the abdomen, which may reveal a cystic lesion in relation to the bowel loops, away from the adjacent viscera. A fluid-fluid level has been reported as a characteristic finding of these cysts which results from an upper fluid level due to the chyle, and a lower fluid level due to the heavier lymph.7 CT scan demonstrates the fluid attenuation of the lesion and its relationship with the adjacent viscera. A characteristic chyle-lymph fluid level has also been described.8 However, in the present series, although the ultrasound and the CT scan were able to detect a cystic lesion in the region of the duodeno-jejunal flexure, away from the adjacent viscera, a definitive preoperative diagnosis of chylolymphatic cyst could not be made. Management of these cysts involves their removal which may or may not involve resection of the adjacent bowel. Most cysts can be enucleated (as in the 1st patient); however, in some this is not possible without sacrifice of the blood supply to the adjacent bowel and hence necessitates resection (as in the 2nd patient). Procedures like marsupialization and drainage are associated with high recurrence rates (as was in the 2nd case) and are best avoided.9 Histopathology of the resected specimen reveals either unilocular or multilocular cysts.10 The cysts are usually lined with single layer of endothelium, and may contain lymphoid tissue and foam cells.4,10