沙鬥菌性結腸炎引起之毒性結腸擴張－一病例報告－

一名40天大的男嬰，因腹脹、發燒、黃疸及血便，疑為腸阻塞合併敗血症而轉來本院。腹部X光攝影顯示腹部中央有一巨大之氣性囊腫，伴有數處氣體液體平面和部分腸環膨脹。病人隨即接受部腹探查，切除顯著擴張且已有發炎及粘連現象的一段橫結腸送病理檢查，同時做近端結腸口術，其後糞便培養長出Salmonella group E，血液培養則為陰性。病理發現符合沙門菌性結陽炎的變化。術後經適當的治療，病情趨穩，開閉結腸造口後出院。由於次發於沙門菌性結腸炎的毒性結腸擴張相當少見，特提出病例報告並討論之。

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並列摘要

Toxic dilatation of the colon s a complication found in non-specific inflammatory bowel disease, either ulcerative colitis or Crohn's disease. Occasionally it may occur in the fulminant toxic phase of typhoid fever, acute bacillary dysentery, amoebic colitis, ischemjc colitis and pseudomembranous colitis. However, its occurrence in salmonella colitis was rarely reported. The pathogenesis of toxic dilatation of the colon is not clear. It seems that any kind of profound inflammatory or infectious disease of the colon may render the colon incapable of performing its function and result in a dilatation. This report describes toxic dilatation of the colon that developed during the course of salmonella colitis in a 40-day-old male baby. Abdominal distension, lethargy, jaundice, poor feeding and bloody stool were the main clinical manifestations. X-ray study of the abdomen revealed marked gaseous distension of a bowel loop and fluid levels. Emergency laparatomy was performed under the impression of intestinal obstruction. A segment of hugely dilated and markedly inflammed transverse colon was found adhered to the surrounding organs. The segment was resected and a colostomy performed. Stool culture. done on admission was reported after surgery to have Salmonella group E. The patient was given a course of antibiotics and the colostomy was closed about S weeks after the primary operation. The baby boy has remained well since. It is important to recognize salmonellosis as a cause of toxic dilatation of the colon since such a lesion may be treated conservatively otherwise and have a good prognosis.

並列關鍵字

toxic dilatation of the colon ； salmonella colitis

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沙鬥菌性結腸炎引起之毒性結腸擴張－一病例報告－

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