Tetsuhara Kenichi, Nakabayashi Kazunobu, Muraoka Mamoru, Kikuno Rie, Ueda Michiko, Inoue Ryo, Hayashida Makoto
Department of Critical Care Medicine Fukuoka Children's Hospital Fukuoka Japan.
Department of Pediatric Surgery Fukuoka Children's Hospital Fukuoka Japan.
Acute Med Surg. 2024 Jun 18;11(1):e977. doi: 10.1002/ams2.977. eCollection 2024 Jan-Dec.
Strangulated intestinal obstruction is a life-threatening condition that should be considered as a differential diagnosis in children with shock. However, it has pitfalls in diagnosis and can lead to diagnostic errors.
A 3-month-old male patient presented with a pale complexion lasting 2 h and abnormal crying. He was in shock with lactic acidosis, altered mental status, and slight abdominal distension. He required volume resuscitation, vasoactive agents, and transfusion. On Day 2, he had marked abdominal distension and acute kidney injury, which required continuous kidney replacement therapy. Contrast-enhanced computed tomography revealed extensive intestinal ischemia. It took 33.5 h from his arrival to the computed tomography, leading to operative management. The small intestine had entered a mesenteric hiatus, leading to ischemia. He was diagnosed with strangulated mesenteric hernia.
In this case, four pitfalls led to delayed diagnosis. Factors for diagnostic errors specific to strangulated intestinal obstruction and intensive care should be noted.
绞窄性肠梗阻是一种危及生命的疾病，在休克儿童中应作为鉴别诊断考虑。然而，其在诊断方面存在陷阱，可能导致诊断错误。
一名3个月大的男性患者出现面色苍白持续2小时及哭闹异常。他处于休克状态，伴有乳酸酸中毒、精神状态改变及轻度腹胀。他需要液体复苏、血管活性药物及输血治疗。第2天，他出现明显腹胀及急性肾损伤，需要持续肾脏替代治疗。增强计算机断层扫描显示广泛的肠缺血。从他到达医院到进行计算机断层扫描用时33.5小时，导致手术治疗。小肠进入肠系膜裂孔，导致缺血。他被诊断为绞窄性肠系膜疝。
在本病例中，四个陷阱导致诊断延迟。应注意绞窄性肠梗阻及重症监护中特定的诊断错误因素。
