Yamamoto L G, Morita S Y, Boychuk R B, Inaba A S, Rosen L M, Yee L L, Young L L
Emergency Services, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826, USA.
Am J Emerg Med. 1997 May;15(3):293-8. doi: 10.1016/s0735-6757(97)90019-x.
This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly. While most of the grossly bloody stools were not consistent with pure currant jelly, the most common terms used in describing the grossly bloody stools were "bloody," "mucus," "red," and "diarrhea." Since stools truly resembling currant jelly account for a minority of the grossly bloody stools in intussusception, the term "currant jelly stools" should be assessed in the teaching of intussusception. Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.
本研究调查了107例住院肠套叠患儿的大便外观描述。56例患儿出现肉眼可见的血便(自行排出),其中10例经病历回顾确定类似果酱样便。在51例未自行排出肉眼可见血便的患儿中,35例有直肠检查结果记录。其中8例患儿直肠检查时发现肉眼可见血便,经病历回顾确定4例类似果酱样便。虽然大多数肉眼可见血便与纯果酱样便不一致,但描述肉眼可见血便最常用的术语是“血性”“黏液”“红色”和“腹泻”。由于真正类似果酱样便的大便在肠套叠肉眼可见血便中占少数,因此在肠套叠教学中应重新评估“果酱样便”这一术语。诸如血液、黏液、紫红色、红色等通用术语在识别肠套叠病例时更客观、更敏感。在教授肠套叠典型表现为果酱样便的初级医生时,还应告知他们,对于任何类型血便的儿童进行鉴别诊断时都应考虑肠套叠。因此,经验有限的医生更有可能恰当地考虑肠套叠的诊断,从而实现更及时的诊断和更好的治疗效果。