新生兒直腸穿孔病例

Rectal Perforation in the Newborn: Report of a Case

李耀星(Yau-Shing Lee) ； 陳德輝(Tou-Hwei Chen) ； 黃富源(Fu-Yuan Huang)

《Acta Paediatrica Sinica》 17卷2期 (1976/06) Pp. 105-108

摘要

新生兒直腸穿孔係屬罕見之病例。1969年以前，文獻上的記載只有10例，以後卻未見新的報告。馬偕醫院於1975年10月間發現一例，可能係國內的第一個病例報告。病人爲6天大的女嬰，在生後第二天即出現腹脹，食慾不振及高燒等病狀。經醫師診治後，燒退，但腹脹日漸加重。入院前一天開始無尿。住院時腹部X-光檢查發現胃腸道穿孔，立即轉入外科作緊急剖腹手術。手術時發現直腸左側在腹膜返折處(peritoneal reflection)有一0.3×0.3cm大的裂孔，周圍組織已呈壞死變化，腹腔內有綠色腹水，Douglas pouch有混濁液沌積。清除壞死組織及冲洗腹腔後，在Douglas pouch置Sump管引流，並做橫行結腸造口術(transverse loop colostomy)，術後併用抗生素及輪液治療，情況逐漸改善，病人於手術後第18天出院，出院時情況良好。引起新生兒大腸直腸穿孔的原因很多，除壞死性腸炎及阻塞性病變之外，約13%乃意外事件造成。本病例出生前可能先有胎便性腹膜炎，生後因外傷再繼發細菌性腹膜炎。手術時直腸以外之腸道沒有先天性異常或其他病變，病人不曾接受灌腸，除肛溫計之外不曾有其他異物揷入肛門。由於未見胎便帶血，無法確定本病例直腸穿孔是否因肛溫計引起。但由於其穿孔部位在肛溫計等外物易損傷的地方，我們建議新生兒在使用肛溫計、肛管或灌腸時應特別小心。

並列摘要

A rare case of rectal perforation in a 6-day-old female newborn is presented. She is the second offspring of a 24-year-old healthy woman. The delivery course was uneventful. Meconium passed within 24 hours after birth. Abdominal distension appeared on the second day of life along with poor feeding and high fever. Although fever subsided after treatment, abdominal distension progressed. Anuria was noted on the fifth day. Physical examination on admission revealed a soft, markedly distended abdomen with normoactive bowel sound. A plain abdominal film showed pneumoperitoneum and some granular shadow on the left lower quadrant. Emergency laparotomy was performed under the impression of hollow viscus perforation. A perforation hole, 0.3×0.3cm in size, was noted at the left lateral wall of the rectum near the peritoneal reflection. There was a lot of fibrinous coating and pus in the Douglas pouch. Drainage and transverse loop colostomy were performed. The postoperative course was uneventful and the patient was discharged 18 days after operation.
The cause of rectal perforation iii this case was not certainly known. Accidents account for 13% of colorectal perforation in the newborn period. The hazards of manipulating the anus and rectum with catheters and thermometers are well known. Great caution should be taken if these firm objects are introduced.