Colón A R, DiPalma J S, Leftridge C A
Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C. 20007.
J Clin Gastroenterol. 1991 Apr;13(2):163-6. doi: 10.1097/00004836-199104000-00009.
In this retrospective analysis we searched for a constellation of signs or symptoms attributable to childhood lymphonodular hyperplasia (LNH). Of 147 children with documented LNH reviewed, 43% had lesions in the small bowel, and 57% in the large bowel. Children in this study presented with complaints of abdominal pain (58%) and bright red blood per rectum (32%). Physical examination revealed little except right lower quadrant (RLQ) abdominal tenderness and "fullness" in 35%. The pain was periumbilical, dull-cramping, rarely acute, and nonradiating. The hematochezia was most commonly streaky red in mucoid strands adhering to the stools, with no associated tenesmus. Three clinical patterns emerged: (a) Under 1 year of age most patients were male, with painless bleeding and pancolonic LNH. (b) Between 2 and 6 years, although the LNH was predominantly colonic, pain and bleeding occurred equally. (c) From 7 years old on, the main symptom was abdominal pain, but LNH distribution was nearly equal between the small bowel and the colon. To date, our long-term follow-up of the children with isolated LNH has revealed no sequelae.
在这项回顾性分析中，我们探寻了可归因于儿童淋巴小结增生（LNH）的一系列体征或症状。在对147例有记录的LNH患儿进行回顾时发现，43%的患儿小肠有病变，57%的患儿大肠有病变。本研究中的患儿主诉腹痛（58%）和直肠鲜红色血便（32%）。体格检查除右下象限（RLQ）腹部压痛和35%的患儿有“饱满感”外，无其他明显异常。疼痛位于脐周，呈钝性绞痛，很少为急性发作，且无放射痛。便血最常见的表现是附着于粪便的黏液样条索状鲜红色血迹，无相关里急后重感。出现了三种临床模式：（a）1岁以下的大多数患儿为男性，有无痛性出血和全结肠LNH。（b）2至6岁的患儿，尽管LNH主要位于结肠，但疼痛和出血的发生率相同。（c）7岁及以上的患儿，主要症状为腹痛，但LNH在小肠和结肠的分布几乎相等。迄今为止，我们对孤立性LNH患儿的长期随访未发现后遗症。
