Idowu J, Razzouk A J, Georgeson K
Department of Surgery, Loma Linda University, CA.
J Pediatr Surg. 1987 Oct;22(10):939-40. doi: 10.1016/s0022-3468(87)80594-8.
Antireflux operations are now commonly performed for severe gastroesophageal reflux with life-threatening presentations like recurrent aspiration pneumonia and apnea. We report a child who presented 2 years after Nissen fundoplication with jejunal volvulus resulting in massive gastric dilatation, gastric rupture, pneumoretroperitoneum, pneumomediastinum, and severely compromised circulation to the lower extremities. Because of the intense intraabdominal pressure from the gastric dilatation, there was severe ischemia of the pancreas, duodenum, small bowel, colon, and gallbladder. We suggest that gastrointestinal symptoms in a child who has had Nissen fundoplication should be promptly evaluated to avoid delay in recognition of acute gastric dilatation and to prevent a fatal outcome.
抗反流手术目前常用于治疗伴有诸如反复吸入性肺炎和呼吸暂停等危及生命表现的严重胃食管反流。我们报告了一名儿童，在进行Nissen胃底折叠术两年后出现空肠扭转，导致胃大量扩张、胃破裂、腹膜后积气、纵隔积气以及下肢循环严重受损。由于胃扩张导致的腹内压增高，胰腺、十二指肠、小肠、结肠和胆囊出现严重缺血。我们建议，对于接受过Nissen胃底折叠术的儿童出现的胃肠道症状应及时评估，以避免延误对急性胃扩张的识别并防止出现致命后果。
