Schullinger J N, Jacobs J C, Berdon W E
J Pediatr Surg. 1985 Oct;20(5):521-4. doi: 10.1016/s0022-3468(85)80479-6.
Four children with dermatomyositis were recently seen with gastrointestinal perforations. The sites of perforation in the four cases were: (1) the duodenum, esophagus, and colon; (2) the duodenum; (3) the distal stomach; and (4) the traverse colon. The gastric and transverse colon perforations were intraperitoneal and easily diagnosed. The gastric perforation was treated successfully by partial gastrectomy. The patient with the colon perforation underwent exteriorization; death occurred from cerebral complications possibly related to vasculitis. Both duodenal perforations were posterior in the distal descending portion. Enzymatic dissection into the right lower quadrant produced confusing clinical and radiographic signs and extensive retroperitoneal necrosis. Successful treatment was obtained by partial gastrectomy, sump drainage of the perforation, and parenteral nutrition. Gastrointestinal perforation is a well-recognized complication of vasculitis in childhood dermatomyositis. In particular, perforations of the distal duodenum, as reported by others, are associated with delay in diagnosis and high mortality.
最近发现4例皮肌炎患儿出现胃肠道穿孔。4例穿孔部位分别为：（1）十二指肠、食管和结肠；（2）十二指肠；（3）胃远端；（4）横结肠。胃和横结肠穿孔为腹腔内穿孔，易于诊断。胃穿孔通过胃部分切除术成功治疗。结肠穿孔患者接受了结肠造瘘术；患者死于可能与血管炎相关的脑部并发症。两例十二指肠穿孔均位于降部远端的后侧。酶解至右下腹产生了混淆的临床和影像学表现以及广泛的腹膜后坏死。通过胃部分切除术、穿孔处的引流和肠外营养成功治愈。胃肠道穿孔是儿童皮肌炎血管炎中一种公认的并发症。特别是，如其他人所报道的，十二指肠远端穿孔与诊断延迟和高死亡率相关。
