Hartman G E, Drugas G T, Shochat S J
Department of Surgery, Stanford University Medical Center, CA 94305.
J Pediatr Surg. 1988 Jun;23(6):562-6. doi: 10.1016/s0022-3468(88)80369-5.
Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
在坏死性小肠结肠炎（NEC）急性期存活下来并接受内科治疗的婴儿中，约三分之一会发生肠道狭窄或缩窄。有人主张通过常规对比灌肠来识别这些病变，以此作为降低因诊断延迟而导致潜在发病率的一种手段。然而，由于病变有显著的自发缓解率，且不愿让无症状的婴儿接受对比灌肠，近期的研究人员已将这些检查保留给在密切观察期间出现梗阻症状的患者。1984年7月至1986年7月，在我们机构接受内科治疗的婴儿中有5名（15%）出现了有症状的狭窄。未常规进行对比灌肠，其中4名（80%）患者出现了与肠梗阻相关的危及生命的败血症或穿孔。两名婴儿在从重症监护病房出院4周和6周后出现完全性结肠梗阻，他们最初能够耐受经口喂养。由于穿孔或败血症，这两名婴儿病情危急，在社区医院接受了急诊结肠造口术。另外两名婴儿在因早产和肺功能不全住院期间出现腹胀、败血症和心肺功能代偿失调。在重症监护病房密切监测下谨慎重新喂养5周和7周后，这些患者出现了症状。这些危及生命的并发症的发生表明，仅靠临床观察对许多此类婴儿的治疗是不够的。应进行对比灌肠，以识别那些有发生此类潜在发病或死亡风险的患者，尤其是那些不住在小儿外科设施附近的婴儿。
