Vadeboncoeur C, Walton J M, Raisen J, Soucy P, Lau H, Rubin S
Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
J Pediatr Surg. 1994 Sep;29(9):1248-9. doi: 10.1016/0022-3468(94)90815-x.
Mucormycosis is an infection caused by a ubiquitous fungus in immunocompromised individuals. Typically, it invades blood vessels, producing thrombosis and tissue infarction. This infection spans all pediatric age groups and can lead to hollow viscus perforation and bowel obstruction. A 30-month old male with large cell anaplastic lymphoma had a bowel obstruction. During emergency laparotomy, an ileoileal intussusception was identified, which required resection and anastomosis. In the pathological specimen, fungi of the Mucorales order were found to be associated with tissue necrosis. On the eighth day of life, a premature infant had abdominal distension secondary to bowel perforation. Partial gastric resection and multiple intestinal stomas were performed. Death occurred soon after, secondary to multiorgan failure. The autopsy and surgical specimens showed widespread mucormycosis. An adolescent had meningococcemia-induced septic shock. During recovery, hemorrhagic colitis developed, which led to perforation. The subtotal colectomy specimen showed widespread mucormycosis. The laparotomy findings are typical (black necrotic tissue involving the bowel), and when seen in the immunocompromised patient, should make one suspect gastrointestinal mucormycosis. Aggressive surgical debridement of devitalized tissue augmented by intravenous antifungal medication is the mainstay of treatment.
毛霉病是一种由普遍存在的真菌引起的感染，多见于免疫功能低下的个体。通常，它会侵袭血管，导致血栓形成和组织梗死。这种感染涵盖所有儿童年龄组，可导致中空脏器穿孔和肠梗阻。一名30个月大的患有大细胞间变性淋巴瘤的男性出现了肠梗阻。在急诊剖腹手术中，发现了回肠套叠，需要进行切除和吻合。在病理标本中，发现毛霉目真菌与组织坏死有关。一名早产儿在出生后第8天因肠穿孔出现腹胀。进行了部分胃切除术和多处肠造口术。术后不久因多器官衰竭死亡。尸检和手术标本显示广泛的毛霉病。一名青少年患有脑膜炎球菌血症引起的感染性休克。在恢复过程中，发生了出血性结肠炎，导致穿孔。次全结肠切除术标本显示广泛的毛霉病。剖腹手术的发现很典型（黑色坏死组织累及肠道），在免疫功能低下的患者中出现时，应怀疑为胃肠道毛霉病。积极的手术清创去除失活组织，并辅以静脉注射抗真菌药物是主要的治疗方法。
