在内脏穿孔的早产儿中,越来越多的人认识到肠道肌肉节段性缺失:病例系列

Carolina Pinzon-Guzman , Alexander Kevorkov , Karl Grenier , Maeve O'Neill Trudeau , Pramod Puligandla , Etienne St-Louis
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引用次数: 0

摘要

导言肠道肌肉组织节段性缺失(SAIM)是一种病理诊断,表示在周围结构完好的情况下,固有肌的局灶性缺失。这种情况通常表现为自发性肠穿孔(SIP),临床上很难将其与坏死性小肠结肠炎(NEC)区分开来。病例介绍我们介绍了 5 例早产儿,胎龄从 24+3 周到 32+1 周不等,他们都在出生后第 15 天前出现肠穿孔。其中 3 名患者出现腹部膨胀和变色,随后在腹部 X 光检查(AXR)中发现腹腔积气。另外两名患者临床症状恶化,但没有肠穿孔迹象,随后在腹部X光检查中发现腹腔积气。所有患者都接受了穿孔肠道切除术,并进行了回肠造口术和粘液瘘或原发性端端吻合术。两名患者在首次手术后一周内因小肠其他部位的新穿孔导致腹腔积气而需要再次进行剖腹探查手术。一名患者在术中出现先天性肝损伤,术后 1 天去世。结论 SAIM 是一种病理诊断,可表现为 SIP,可能意味着因内脏穿孔而接受肠切除术的早产儿在没有明确病因的情况下有复发腹膜炎的风险。
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Segmental absence of intestinal musculature increasingly recognized in premature infants with perforated viscus: A case series

Introduction

Segmental absence of intestinal musculature (SAIM) is a pathological diagnosis, denoting focal absence of the muscularis propria in the presence of intact surrounding structures. This condition often presents as spontaneous intestinal perforation (SIP) and can be difficult to distinguish clinically from necrotizing enterocolitis (NEC).

Case presentations

We present 5 cases of premature babies with gestational age ranging from 24 + 3 weeks up to 32 + 1 weeks, who all presented with intestinal perforation before the 15th day of life. Three patients presented with a distended abdomen and discoloration and were subsequently found to have pneumoperitoneum on abdominal x-ray (AXR). The 2 other patients presented with clinical deterioration but without signs of intestinal perforation and were subsequently found to have pneumoperitoneum on AXR. All underwent bowel resection of perforated bowel with either ileostomy with mucous fistula or primary end-to-end anastomosis. Two patients required repeat exploratory laparotomies within a week of their initial surgery due to pneumoperitoneum in subsequent AXR caused by new perforations in other parts of the small bowel. One patient sustained an iatrogenic liver injury intra-operatively and passed away 1 day post-operatively. All patients were found to have SAIM on histopathological examination.

Conclusion

SAIM is a pathological diagnosis that can manifest as SIP and may denote a risk for recurrent peritonitis in premature infants who underwent bowel resection for perforated viscus without a clear etiology.
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
期刊最新文献
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