Grant H W, Hadley G P, Wiersma R, Rollins N
Department of Paediatric Surgery and Medical Paediatrics, University of Natal, Durban, South Africa.
J R Coll Surg Edinb. 1998 Jun;43(3):160-2.
An epidemic of Shigella dysenteriae type I is spreading through Africa. It is a particularly infectious and virulent form of dysentery which can cause clinical confusion with other endemic diseases and may present to the surgeon as a result of its complications. A total of 140 children with Shigella dysenteriae type I presented to the paediatricians at King Edward VIII Hospital in 1995; 35 were referred to the surgeons because of abdominal tenderness, distension, peritonitis or perforation. Ten children underwent laparotomy--four for peritonitis and six for perforation. Of the four children with peritonitis, three had transmural colitis. Therefore laparotomy was only performed for objective evidence of perforation. Of the subsequent non-operated group with the clinical features of peritonitis, none developed further surgical problems in the acute phase and none died. It is suggested that surgery in the acute phase should be avoided unless there is evidence of perforation.
I型志贺氏痢疾正在非洲蔓延。它是一种传染性特别强且毒性大的痢疾形式，会与其他地方病在临床上造成混淆，并且可能因其并发症而被送至外科医生处。1995年，共有140名患I型志贺氏痢疾的儿童被送到爱德华八世国王医院的儿科医生处；35名因腹部压痛、腹胀、腹膜炎或穿孔被转至外科医生处。10名儿童接受了剖腹手术——4名因腹膜炎，6名因穿孔。在4名患腹膜炎的儿童中，3名有透壁性结肠炎。因此，仅在有穿孔的客观证据时才进行剖腹手术。在随后具有腹膜炎临床特征的非手术组中，急性期无人出现进一步的外科问题，也无人死亡。建议除非有穿孔证据，否则急性期应避免手术。
