Yokoyama S, Soeda J, Fujimoto T, Mitomi T
Department of Surgery, Tokai University, School of Medicine, Isehara, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1556-8.
The site and nature of lesions producing gastrointestinal bleeding was evaluated in pediatric patients admitted to Tokai University Hospital. The differential diagnosis was possible based upon the character of the bleeding and the age of the patient. Upper endoscopy is the diagnostic maneuver of choice in evaluating the upper gastrointestinal bleeders. Sigmoidoscopy, colonoscopy, technetium scans, tagged red cell scans and intraoperative angiography were helpful in locating bleeding sites of lower bleeders. Common causes of bleeding were as follows: Hemorrhagic disease, necrotizing enterocolitis, and midgut volvulus in neonates; intussusception and internal hernia in infants; juvenile polyp and infectious diarrhea in children; duodenal ulcer and ulcerative colitis in adolescents. Gastro-duodenal ulcers were found in all age groups. One neonate died of indomethacin induced bleeding, however, bleeding from acute ulcer was usually controlled by conservative treatments. Increasing frequency of variceal bleeding due to portal hypertension after successful Kasai procedure for congenital biliary atresia was emphasized.
对东海大学医院收治的儿科患者中导致胃肠道出血的病变部位及性质进行了评估。根据出血特征及患者年龄可进行鉴别诊断。上消化道内镜检查是评估上消化道出血患者的首选诊断手段。乙状结肠镜检查、结肠镜检查、锝扫描、标记红细胞扫描及术中血管造影有助于定位下消化道出血部位。出血的常见原因如下：新生儿期为出血性疾病、坏死性小肠结肠炎及中肠扭转；婴儿期为肠套叠及内疝；儿童期为幼年性息肉及感染性腹泻；青少年期为十二指肠溃疡及溃疡性结肠炎。各年龄组均发现有胃十二指肠溃疡。1例新生儿死于吲哚美辛所致出血，不过，急性溃疡出血通常可通过保守治疗得到控制。强调了先天性胆道闭锁行葛西手术后因门静脉高压导致静脉曲张出血的频率增加。
