Misericordia M, Bolli V, Marconi E, Pasqualini M, Pieroni G, Pupillo M C, Fabrizzi G
Servizio di Radiologia, Ospedale Pediatrico G. Salesi, Ancona.
Radiol Med. 1994 Oct;88(4):425-8.
This study was aimed at investigating the role of US in the newborn with a clinical suspicion of hemoperitoneum. Hemoperitoneum is a dramatic clinical event which may be caused by some obstetrical and fetal factors--breech or complicated delivery, hepatomegaly, macrosomy, anoxic liver congestion being the most frequent causes. Direct or indirect trauma of an abdominal organ during delivery represents the major pathogenetic factor. Clinical symptoms are correlated with the appearance of shock whose intensity is proportional to trauma severity: symptoms may appear even 48 hours after delivery. The authors report their experience with 4 consecutive cases of neonatal hemoperitoneum which underwent US of the abdomen 24 to 72 hours after birth. In the first 3 newborns, US was performed on the basis of a clinical picture of bleeding shock, while in the extant newborn US was performed after a sudden increase in blood transaminase level associated with an obstetrical paralysis of the left arm. The US examinations were performed using a 7.5-MHz sectorial probe unit (Siemens). In all patients, US demonstrated the presence of a liquid effusion in the abdomen which could be referred to hemoperitoneum. In two patients, it was associated with a traumatic focal alteration of the liver parenchyma, in the third with a diffuse subcapsular liver hematoma and, finally in the fourth patient with a disconnected splenic vascular pedicle which was at surgery demonstrated. In conclusion, US is indicated as the most reliable and valuable diagnostic technique in the study of neonatal hemoperitoneum. The authors believe abdominal US to be essential in all the neonatal cases where hemoperitoneum is suspected and in selected cases presenting specific risk factors, to allow a rapid diagnosis and better treatment planning.
本研究旨在探讨超声在临床怀疑有腹腔积血的新生儿中的作用。腹腔积血是一种严重的临床事件，可能由一些产科和胎儿因素引起——臀位或复杂分娩、肝肿大、巨大儿、缺氧性肝充血是最常见的原因。分娩期间腹部器官的直接或间接创伤是主要的致病因素。临床症状与休克的出现相关，休克的严重程度与创伤的严重程度成正比：症状甚至可能在分娩后48小时出现。作者报告了他们对4例连续新生儿腹腔积血病例的经验，这些病例在出生后24至72小时接受了腹部超声检查。在前3例新生儿中，超声检查是基于出血性休克的临床表现进行的，而在第4例新生儿中，超声检查是在与左臂产科麻痹相关的血转氨酶水平突然升高后进行的。超声检查使用7.5MHz扇形探头装置（西门子）进行。在所有患者中，超声均显示腹腔内有液体积聚，提示为腹腔积血。在2例患者中，伴有肝实质的创伤性局灶性改变，第3例伴有弥漫性肝包膜下血肿，最后在第4例患者中，超声显示脾血管蒂离断，手术中得到证实。总之，超声被认为是研究新生儿腹腔积血最可靠和最有价值的诊断技术。作者认为，在所有怀疑有腹腔积血的新生儿病例以及在某些存在特定危险因素的病例中，腹部超声对于快速诊断和更好地制定治疗计划至关重要。
