Brisighelli Giulia, Lorentz Liam, Pillay Tanyia, Westgarth-Taylor Christopher J
Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Department of Radiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
European J Pediatr Surg Rep. 2020 Jan;8(1):e39-e44. doi: 10.1055/s-0040-1709140. Epub 2020 May 14.
In patients with anorectal malformations and a colostomy, the high-pressure distal colostogram is the technique of choice to determine the type of malformation and thus to plan the surgical repair. Perforations associated with high-pressure distal colostograms are very rare. The aim of our study was to identify pitfalls to prevent perforation secondary to high-pressure distal colostogram. The study included two male patients and was complicated with rectal perforations secondary to high-pressure distal colostogram. Both patients had an imperforate anus without a fistula. One patient had extraperitoneal rectal perforation with progressive contrast spillage into the peritoneum and demised. The other patient developed an extraperitoneal perforation and an associated necrotizing fasciitis of his perineum and scrotum, but he recovered well after debridement. Two further cases of rectal perforation have been described in the literature. Rectal perforation, although rare, is a described life-threatening complication secondary to high-pressure distal colostogram. The cause is excessive contrast pressure. Injection of contrast should be stopped once the distal end of the colon has a convex shape. Intraperitoneal perforation may cause hypovolemic/septic shock, and patients need to be appropriately resuscitated and should undergo laparotomy. Extraperitoneal perforation requires close monitoring for possible local complications, which may necessitate early debridement.
对于患有肛门直肠畸形并接受结肠造口术的患者，高压远端结肠造影是确定畸形类型从而规划手术修复方案的首选技术。与高压远端结肠造影相关的穿孔非常罕见。我们研究的目的是找出可预防高压远端结肠造影继发穿孔的陷阱。该研究包括两名男性患者，均因高压远端结肠造影继发直肠穿孔。两名患者均为无瘘的肛门闭锁。一名患者发生腹膜外直肠穿孔，造影剂逐渐渗入腹膜，最终死亡。另一名患者出现腹膜外穿孔，并伴有会阴部和阴囊坏死性筋膜炎，但清创术后恢复良好。文献中还描述了另外两例直肠穿孔病例。直肠穿孔虽然罕见，但却是高压远端结肠造影继发的一种危及生命的并发症。其原因是造影剂压力过大。一旦结肠远端呈凸形，就应停止注射造影剂。腹膜内穿孔可能导致低血容量性/感染性休克，患者需要进行适当的复苏，并应接受剖腹手术。腹膜外穿孔需要密切监测是否可能出现局部并发症，这可能需要早期清创。
