Charbit-Henrion Fabienne, Chardot Christophe, Ruemmele Frank, Talbotec Cécile, Morali Alain, Goulet Olivier, Colomb Virginie
*Department of Pediatric Gastroenterology-Hepatology and Nutrition †Department of Pediatric Surgery and Transplantation, Hôpital Necker-Enfants Malades ‡Department of Pediatric Gastroenterology-Hepatology and Nutrition, Hôpital d'Enfants de Brabois, Vandoeuvre-les-Nancy, France.
J Pediatr Gastroenterol Nutr. 2014 Oct;59(4):531-6. doi: 10.1097/MPG.0000000000000472.
Anastomotic ulceration (AU) is a rare complication after intestinal resection and anastomosis, described mostly in children. The main symptom is occult bleeding, leading to iron-deficiency anemia, which is life threatening.
The present survey reports a series of patients with AU after intestinal resection in infancy, focusing on predictive factors, medical and surgical treatment options, and long-term outcomes. Eleven patients (7 boys) born between 1983 and 2005 with AU after an intestinal resection and anastomosis in infancy were included in this retrospective review.
The diagnosis of AU was often delayed for several years. No predictive factor (including the primary disease, the length of the remnant bowel, and the loss of the ileocaecal valve) could be identified. Numerous treatment options, including antibiotics and anti-inflammatory drugs, proved to be ineffective to induce prolonged remission. Even after surgical resection, relapses were observed in 5/7 children.
The mechanism leading to AU remains unknown. Contrary to previous reports with limited follow-up, no medical or surgical treatment could prevent recurrences. Because relapses may occur several years after treatment, long-term follow-up is needed.
吻合口溃疡（AU）是肠切除吻合术后一种罕见的并发症，多见于儿童。主要症状为隐匿性出血，可导致缺铁性贫血，危及生命。
本调查报道了一系列婴儿期肠切除术后发生AU的患者，重点关注预测因素、内科及外科治疗方案以及长期预后。本回顾性研究纳入了1983年至2005年间出生、婴儿期肠切除吻合术后发生AU的11例患者（7例男性）。
AU的诊断常延迟数年。未发现任何预测因素（包括原发病、残余肠管长度及回盲瓣缺失）。包括抗生素和抗炎药在内的多种治疗方案均被证明无法有效诱导长期缓解。即使手术切除后，7例患儿中有5例复发。
导致AU的机制尚不清楚。与既往随访有限的报道相反，没有内科或外科治疗能够预防复发。由于复发可能在治疗后数年发生，因此需要进行长期随访。
