Ein S H, Shandling B, Reilly B J, Stringer D A
J Pediatr Surg. 1986 Oct;21(10):883-6. doi: 10.1016/s0022-3468(86)80014-8.
It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.
一般认为，由铅垂点引起的肠套叠不能通过水压钡灌肠复位。这在几年前就有报道，并且一直是一个一致的发现，促使我们尝试对婴儿和儿童的复发性肠套叠以及首次发生肠套叠的大龄儿童进行水压钡灌肠复位。然而，在过去9年里，我们治疗了5名儿童，他们的回结肠型肠套叠由铅垂点引起，但通过水压钡灌肠得以复位。这些患儿的病史和体格检查与普通小儿肠套叠患者并无不同。经钡灌肠诊断的回结肠型肠套叠在钡剂充分反流至回肠末端时得以复位。然而，结肠或回盲部区域残留且持续存在的充盈缺损使得剖腹手术成为必要。在所有5例病例中，均发现了铅垂点并进行了切除。这一经验向我们表明，在回肠末端似乎已充分充盈之后，钡剂柱内残留的管腔内充盈缺损应被解释为铅垂点，并提示需要进行剖腹手术。
