Johnson J E, Carpenter B L, Benton J, Cross R, Eaton L A, Rhoads J M
Department of Medicine, University of North Carolina, Chapel Hill 27599-7220.
J Pediatr Gastroenterol Nutr. 1991 May;12(4):501-6. doi: 10.1097/00005176-199105000-00015.
This report describes a toddler with chronic diarrhea, vomiting, and hypotonia due to surreptitious administration of syrup of ipecac by his mother (Munchausen's syndrome by proxy). Several features of this case distinguish it from previous reports of chronic ipecac ingestion in childhood: the development of grossly bloody stools; radiologic, endoscopic, and biopsy evidence of a chronic moderate colitis resembling ulcerative colitis; and the histologic finding of pseudomelanosis coli, providing an important clue to toxic ingestion. The significance and possible mechanism for genesis of pseudomelanosis coli is discussed. This case emphasizes the variability in presentation and difficulty in diagnosing long-term ipecac ingestion by proxy. Ipecac toxicity should be considered in children with unexplained colitis and vomiting.
本报告描述了一名幼儿，因母亲暗中给他服用吐根糖浆（代理孟乔森综合征）而出现慢性腹泻、呕吐和肌张力减退。该病例的几个特征使其有别于以往儿童慢性摄入吐根的报告：出现肉眼可见的血便；影像学、内镜检查和活检显示存在类似溃疡性结肠炎的慢性中度结肠炎；以及结肠黑变病的组织学发现，这为中毒摄入提供了重要线索。文中讨论了结肠黑变病发生的意义和可能机制。该病例强调了代理长期摄入吐根在临床表现上的变异性以及诊断的困难。对于患有不明原因结肠炎和呕吐的儿童，应考虑吐根中毒的可能性。
