Yeh Pai-Jui, Chao Hsun-Chin, Chen Chien-Chang, Lai Jin-Yao, Lai Ming-Wei
Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Front Pediatr. 2021 Dec 14;9:753076. doi: 10.3389/fped.2021.753076. eCollection 2021.
Antral web is a rare cause of gastric outlet obstruction in children. The presentation is diverse, depending on the degree of obstruction. Unfortunately, the guidance of management is still lacking. This study retrospectively evaluated the presentations, management, and outcomes of the pediatric antral web based on a 20-year experience in a referral center. A total of 23 cases were included. The median age of diagnosis was 10 months (interquartile range, IQR, 0.8-23 months). Main presentations comprised vomiting (83%) and upper gastrointestinal (UGI) bleeding (48%). Concurrent gastric ulcers were common (68%). A total of 13 cases (57%) underwent interventional treatment. The median duration from diagnosis to intervention (DtI) was 10 days, but five with longer DtI, ranged from 30 to 755 days. Among the 15 cases with concurrent gastric ulcers, 10 patients received intervention, immediately in six but delayed in four. Surgical treatments ( = 12) achieved a cure in 11, with one rescued by endoscopic treatment. Children who suffer from early gastric ulcers with outlet obstruction shall raise the suspicion of the antral web. Complete obstruction madates early intervention. Around half of the cases with adequate feeding and growth need no intervention. Recurrent obstructive symptoms or adjacent ulcers justify a switch from observation to intervention to avoid complications or growth faltering.
胃窦隔膜是儿童胃出口梗阻的罕见原因。其表现多样，取决于梗阻程度。遗憾的是，目前仍缺乏治疗指导。本研究基于一家转诊中心20年的经验，对小儿胃窦隔膜的表现、治疗及预后进行了回顾性评估。共纳入23例病例。诊断时的中位年龄为10个月（四分位间距，IQR，0.8 - 23个月）。主要表现包括呕吐（83%）和上消化道（UGI）出血（48%）。并发胃溃疡很常见（68%）。共有13例（57%）接受了介入治疗。从诊断到干预（DtI）的中位时间为10天，但有5例DtI较长，范围为30至755天。在15例并发胃溃疡的病例中，10例患者接受了干预，其中6例立即进行，4例延迟进行。手术治疗（n = 12）使11例治愈，1例经内镜治疗挽救。患有早期胃溃疡伴出口梗阻的儿童应怀疑胃窦隔膜。完全梗阻需要早期干预。约一半喂养和生长良好的病例无需干预。反复出现梗阻症状或邻近溃疡表明应从观察转为干预，以避免并发症或生长发育迟缓问题。
