Oğuzkurt P, Senocak M E, Ciftci A O, Tanyel F C, Büyükpamukçu N
Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
J Pediatr Surg. 2000 Aug;35(8):1161-4. doi: 10.1053/jpsu.2000.8718.
The records of 4 patients who had necrotic bowel secondary to acute mesenteric vascular occlusion affecting various levels of mesenteric vasculature were reviewed to determine the clinical manifestations, diagnostic investigations, predisposing factors, complications, and outcome of mesenteric vascular thrombosis in children.
The medical records of the patients (3 boys, 1 girl) treated between 1981 and 1996, inclusive, for bowel infarction secondary to mesenteric vascular thrombosis, were reviewed with regard to signs and symptoms, laboratory tests, radiological investigations, surgical findings, histopathologic examinations, and outcome.
The ages of the patients ranged between 1 and 14 years with a mean age of 8.2 years. Initial symptoms, present in all patients, were abdominal pain, abdominal distension, and tenderness. Laboratory and radiological findings including abdominal radiographs and abdominal ultrasonography were nondiagnostic. Selective superior mesenteric angiography showed complete obliteration of the superior mesenteric artery with absence of venous return in 1 case. Three patients with massive intestinal necrosis died of multiorgan failure or the complications of short bowel syndrome. Histological examination of the resected intestinal segments showed the typical findings of polyarteritis nodosa in 2 patients. One patient had a previous history of right femoral vein thrombosis, whereas 1 patient had no known underlying disorders predisposing vascular thrombosis.
Mesenteric vascular occlusion is a rare but serious disease leading to death in children. The patients present with similar clinical signs, most frequent and important are acute abdominal pain, vomiting, and distension. Mesenteric vascular occlusion is a rare cause of acute abdomen in childhood, which requires urgent diagnosis and intervention. In suspected mesenteric vascular insufficiency, angiography should be performed followed by intraarterial thrombolytic infusion therapy in selected cases. When intestinal infarction is suspected, immediate surgical resection of compromised bowel is necessary with appropriate postoperative anticoagulation or treatment of any underlying disease.
回顾4例因急性肠系膜血管闭塞继发肠坏死且累及不同肠系膜血管水平的患儿记录，以确定儿童肠系膜血管血栓形成的临床表现、诊断检查、易感因素、并发症及预后。
回顾1981年至1996年（含）间因肠系膜血管血栓形成继发肠梗死接受治疗的患者（3名男孩，1名女孩）的病历，内容包括体征和症状、实验室检查、放射学检查、手术所见、组织病理学检查及预后。
患者年龄在1至14岁之间，平均年龄8.2岁。所有患者的初始症状均为腹痛、腹胀和压痛。包括腹部X线片和腹部超声在内的实验室及放射学检查结果均无诊断意义。选择性肠系膜上动脉造影显示1例肠系膜上动脉完全闭塞且无静脉回流。3例广泛肠坏死患者死于多器官功能衰竭或短肠综合征并发症。对切除肠段的组织学检查显示2例患者有结节性多动脉炎的典型表现。1例患者既往有右股静脉血栓形成史，而1例患者无已知的易导致血管血栓形成的基础疾病。
肠系膜血管闭塞是一种罕见但严重的儿童致死性疾病。患者表现出相似的临床体征，最常见且重要的是急性腹痛、呕吐和腹胀。肠系膜血管闭塞是儿童急性腹痛的罕见原因，需要紧急诊断和干预。在怀疑肠系膜血管功能不全时，应进行血管造影，部分病例可随后进行动脉内溶栓输注治疗。当怀疑肠梗死时，必须立即手术切除受损肠段，并在术后进行适当的抗凝治疗或治疗任何基础疾病。
