Jain Amish, Godambe Sunit V, Clarke Simon, Chow Peter C M
Imperial College Healthcare NHS Trust, Division of Neonatology, Winnicott Baby Unit, St Mary's Hospital, London, W2 1NY, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.03.2009.1708. Epub 2009 Jul 26.
The present report concerns a case of unusually late presentation of lactobezoar, or inspissated milk curd obstruction, leading to necrotising enterocolitis (NEC) in an extremely low birthweight (ELBW) boy infant, born at 26 weeks gestation with a birth weight of 750 g. He deteriorated acutely on day 84 of postnatal age (corrected age 38 weeks) needing intermittent positive pressure ventilation (IPPV). Over the next 3 days he developed signs of NEC, though a radiograph showed no diagnostic features. In view of increasing abdominal distension, silent abdomen and increasing ventilatory requirements, an emergency exploratory laparotomy was performed. The laparotomy revealed inspissated milk curd obstruction in the terminal ileum. There was also a small area of NEC at the ileocaecal valve. A limited hemicolectomy was performed with creation of an ileostomy and mucous fistula. Following this procedure his clinical status improved. Feeds were reintroduced after 7 days and he was on full enteral feeds by 14 days.
本报告涉及一例罕见的迟发性乳石（即浓缩乳凝块梗阻）病例，该病例导致一名孕26周出生、体重750克的极低出生体重（ELBW）男婴发生坏死性小肠结肠炎（NEC）。出生后84天（矫正年龄38周）时，他病情急剧恶化，需要间歇性正压通气（IPPV）。在接下来的3天里，他出现了NEC的症状，尽管X光片未显示出诊断特征。鉴于腹胀加剧、腹部无肠鸣音以及通气需求增加，遂进行了急诊剖腹探查术。剖腹探查发现回肠末端有浓缩乳凝块梗阻。在回盲瓣处也有一小片NEC区域。实施了有限的半结肠切除术，并进行了回肠造口术和黏液瘘管造口术。手术后，他的临床状况有所改善。7天后重新开始喂食，14天时已完全经口喂养。
