Beasley Spencer W
Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
J Paediatr Child Health. 2017 Nov;53(11):1118-1122. doi: 10.1111/jpc.13738.
Intussusception may be difficult to diagnose because the classical triad of symptoms is evident at the time of presentation in only about 20% of cases. This may lead to delays in making the correct diagnosis. The most common presenting features are colicky abdominal pain, vomiting, pallor, lethargy and listlessness. In recent years, the algorithms of management of intussusception have changed significantly: a routine plain abdominal X-ray has been replaced by ultrasonography, previously perceived contraindications to attempting an enema reduction no longer apply, gas has largely replaced barium for enema reduction, incomplete initial reduction is an indication for a delayed repeat enema if the child is stable clinically and partial reduction has been achieved, the indications for surgery have been tightened and laparoscopy affords an alternative surgical approach. This commentary expands on the rationale behind some of the recent advances in the management of children who present with suspected intussusception.
肠套叠可能难以诊断，因为典型的三联征症状仅在约20%的病例就诊时出现。这可能导致正确诊断的延迟。最常见的临床表现是绞痛性腹痛、呕吐、面色苍白、嗜睡和倦怠。近年来，肠套叠的治疗方案发生了显著变化：常规腹部平片已被超声检查取代，以前认为尝试灌肠复位的禁忌证不再适用，气体已在很大程度上取代钡剂用于灌肠复位，如果患儿临床情况稳定且已实现部分复位，初次复位不完全是延迟重复灌肠的指征，手术指征已收紧，腹腔镜提供了另一种手术方法。本评论阐述了疑似肠套叠患儿治疗中一些最新进展背后的原理。
