Huang Y C, Ho M Y, Huang F Y, Hsu J C
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1990 Jan-Feb;31(1):53-7.
A 6-month-old little boy presented with fever and cervical lymphadenopathy for four days. On admission, he was found to have conjunctival congestion of both eyes, reddened and fissured lips, straw-berry tongue, macular rash at the trunk and erythematous change on the BCG injection site. The diagnosis of Kawasaki disease was made and aspirin therapy (100 mg/kg/day) was started. On the 3rd hospital day, he developed abdominal distention, jaundice, poor activity and tachypnea. Bowel sound was silent on auscultation. Nasogastric tube was inserted for decompression and bilious material was drained out continuously. In addition, bloody, mucoid stool passage was noted. An abdominal radiography revealed dilatation of the small bowel and paucity of the colon gases. On the abdominal ultrasound, hydrops of gallbladder, marked ascites and silent and dilated bowel loops were found. Despite of supportive care, abdominal symptoms persisted and condition deteriorated. Laparotomy was done on the following day. At operation, it was found that the patient developed severe petechia on the long segment of small intestine from 15cm distal to the Treitz ligament to ileocecal valve and some fibrin plagues on the terminal ileum at 25cm proximal to the ileocecal valve were also found.
一名6个月大的小男孩因发热和颈部淋巴结肿大4天入院。入院时发现双眼结膜充血、嘴唇发红皲裂、草莓舌、躯干有斑丘疹以及卡介苗接种部位有红斑改变。诊断为川崎病，并开始使用阿司匹林治疗（100毫克/千克/天）。住院第3天，他出现腹胀、黄疸、活动减少和呼吸急促。听诊肠鸣音消失。插入鼻胃管进行减压，持续引出胆汁样物质。此外，发现有血性、黏液样大便。腹部X线片显示小肠扩张，结肠气体减少。腹部超声检查发现胆囊积液、大量腹水以及肠管无声且扩张。尽管给予了支持治疗，腹部症状仍持续存在且病情恶化。次日进行了剖腹探查术。手术中发现，患者从屈氏韧带远端15厘米至回盲瓣的小肠长段出现严重瘀点，在回盲瓣近端25厘米处的回肠末端也发现了一些纤维蛋白斑。
