Chew Siu Jun, Victor Rajadurai Samuel, Gopagondanahalli Krishna Revanna, Chandran Suresh
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Duke NUS Medical School, Singapore.
BMJ Case Rep. 2018 Mar 28;2018:bcr-2018-224356. doi: 10.1136/bcr-2018-224356.
Gastric pneumatosisis a very rare site of pneumatosis intestinalis (PI), and we report this finding in a preterm female infant with cyanotic congenital heart disease. The infant was stable initially on nasal intermittent mandatory ventilation; however, torrential pulmonary flow through a large patent ductus arteriosus prompted closure using oral ibuprofen. After an episode of haematochezia, she developed PI, affecting mainly the gastric wall and small intestine with portal venous gas. Her bowel movements were regular, with no abdominal distension or significant gastric aspirates. She was haemodynamically stable with negative infective markers. Management consisted of endotracheal intubation and ventilation, gastric decompression and broad-spectrum antibiotics. Both the gastric and intestinal pneumatosis resolved within 24 hours and she made an uneventful recovery. If PI is not due to necrotising enterocolitis, enteral nutrition can be initiated early and prolonged course of broad-spectrum antibiotics could have been avoided.
胃壁积气是肠壁积气（PI）非常罕见的部位，我们报告了一名患有青紫型先天性心脏病的早产女婴出现这一情况。该婴儿最初通过鼻间歇强制通气情况稳定；然而，经大型动脉导管未闭的大量肺血流促使使用口服布洛芬进行封堵。在一次便血发作后，她出现了PI，主要累及胃壁和小肠并伴有门静脉积气。她的排便规律，无腹胀或大量胃内容物吸出。她血流动力学稳定，感染指标为阴性。治疗包括气管插管和通气、胃减压及广谱抗生素治疗。胃壁和肠壁积气在24小时内均消失，她顺利康复。如果PI不是由坏死性小肠结肠炎引起，可早期开始肠内营养，避免使用延长疗程的广谱抗生素。
