Azarow K, Connolly B, Babyn P, Shemie S D, Ein S, Pearl R
Department of Surgery (Division of General Surgery), The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Pediatr Surg Int. 1998 Jul;13(5-6):355-9. doi: 10.1007/s003830050338.
Abdominal distention and metabolic acidosis are common in critically ill infants and children, and can be manifestations of an intra-abdominal catastrophe. This series demonstrates the value of bedside sonography (US) in this difficult assessment. Eight infants and children presented with the above situation. Seven were immediately post-cardiopulmonary resuscitation and none had antecedent histories of abdominal pain or bilious vomiting. Abdominal radiographs could not rule out intra-abdominal pathology such as ischemic bowel. Review of all laboratory and radiological data showed US to be a discerning modality for acute bowel pathology. A characteristic pattern of echogenic ascites, thickened bowel wall, dilated, fluid-filled bowel lumen, and lack of peristalsis was seen in those children with gangrenous bowel. Sonographic examination accurately predicted the status of the bowel in all patients. Four patients survived: two had segmental ileal necrosis, one had localized gangrene of the jejunum (twice), and one had necrotic bowel from a closed-loop obstruction. The four who died had malrotation with volvulus (two), superior mesenteric venous thrombosis, and one was immunocompromised with pulmonary aspiration. We conclude that bedside US can be extremely valuable as an adjunct in assessing the abdomen and diagnosing gangrenous bowel in critically ill infants and children.
腹胀和代谢性酸中毒在危重症婴幼儿中很常见，可能是腹内严重病变的表现。本系列病例展示了床旁超声检查（US）在这种困难评估中的价值。8例婴幼儿出现上述情况。其中7例为心肺复苏术后即刻，且均无前驱腹痛或胆汁性呕吐病史。腹部X线片无法排除诸如缺血性肠病等腹内病变。回顾所有实验室和影像学资料显示，超声检查是诊断急性肠道病变的一种有鉴别力的检查方法。在患有坏疽性肠病的患儿中可见特征性的高回声腹水、肠壁增厚、肠腔扩张且充满液体以及蠕动消失的表现。超声检查准确预测了所有患者的肠道状况。4例患者存活：2例为节段性回肠坏死，1例为空肠局限性坏疽（2次），1例为闭袢性肠梗阻导致的坏死性肠病。死亡的4例患者分别为旋转不良伴肠扭转（2例）、肠系膜上静脉血栓形成，以及1例因肺部误吸导致免疫功能低下。我们得出结论，床旁超声作为评估危重症婴幼儿腹部和诊断坏疽性肠病的辅助手段可能极具价值。
