Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2014 Jan;55(1):157-61. doi: 10.3349/ymj.2014.55.1.157.
The term benign transient non-organic ileus of neonates (BTNIN) is applied to neonates who present symptoms and plain radiographic findings of Hirschsprung's disease, but do not have aganglionic bowel and are managed well by conservative treatment. It can often be difficult to diagnose BTNIN because its initial symptoms are similar to those of Hirschsprung's disease. The aim of this study is to evaluate the clinical characteristics and proper treatment of BTNIN.
A retrospective review was made on the clinical data of 19 neonates who were treated for BTNIN between January 2008 and December 2011 at a single facility.
Abdominal distension occurred in every patient (19/19). Other common symptoms included emesis (5/19), explosive defecation (5/19), and constipation (4/19). The vast majority of patients (15/19) experienced the onset of symptoms between 2 and 4 weeks of age. Radiograph findings from all of the patients were similar to Hirschsprung's disease. A barium study showed a transition zone in 33.4% (6/18) of the patients. However, rectal biopsy revealed ganglion cells in the distal rectum in 88.2% (15/17) of the patients, and anorectal manometry showed a normal rectoanal inhibitory reflex in 90% (9/10). All patients responded well to conservative treatment. Symptoms disappeared at the mean age of 4.9±1.0 months, and the abdominal radiographs normalized.
BTNIN had an excellent outcome with conservative treatment, and must be differentiated from Hirschsprung's disease. A rectal biopsy and anorectal manometry were useful diagnostic tools in the differential diagnosis.
新生儿良性暂时性非器质性肠梗阻（BTNIN）这一术语用于描述出现巨结肠病的症状和普通 X 线表现但不存在无神经节细胞肠段并经保守治疗效果良好的新生儿。由于其初始症状与巨结肠病相似，因此常常难以诊断 BTNIN。本研究旨在评估 BTNIN 的临床特征和恰当的治疗方法。
回顾性分析 2008 年 1 月至 2011 年 12 月在单家医疗机构接受 BTNIN 治疗的 19 例新生儿的临床资料。
所有患者均有腹胀（19/19）。其他常见症状包括呕吐（5/19）、爆发性排便（5/19）和便秘（4/19）。绝大多数患者（15/19）在 2 至 4 周龄时出现症状。所有患者的 X 线片表现均类似于巨结肠病。钡剂研究显示有 33.4%（6/18）的患者存在过渡区。然而，直肠活检显示远端直肠中有神经节细胞（15/17），直肠肛门测压显示直肠肛门抑制反射正常（9/10）。所有患者均对保守治疗有良好反应。症状在平均 4.9±1.0 月龄时消失，腹部 X 线片恢复正常。
BTNIN 经保守治疗后效果良好，必须与巨结肠病相鉴别。直肠活检和直肠肛门测压是鉴别诊断的有用工具。
