- 期刊
Spontaneous Focal Intestinal Perforation in Prematurity:Report of Three Cases
早産兒發性局部腸穿孔：三病例報告
摘要
臺大醫院在過去3年經歷了3例早產新生兒發生自發性局部腸穿孔的病例。 3例出生體重均在1500公克左右；其臨床表現均為腹漲、厭食、活力差及呼吸窘迫。剖腹術前均懷疑壞死性腸炎合併腸穿孔；但術中腹內檢查除局部腸穿孔外，並無腸壞死或其他先天腸胃道畸形存在。第 1例穿孔位置在迴腸尾端，術式為破裂段切除加上腸吻合術；第 2，3 例則於盲腸發生穿孔，術式為迴腸造口術，腹水細菌培養分別長出 E. coli, Enterobacter cloacae 及 Klebsiella pueumonia,直腸黏膜生檢均無先天性巨大結腸症之證據。迄今為止，3 例均發育正常，消化機能更好。 吾人認為早產兒或極低體重兒之自發性局部腸穿孔與常見的壞死性腸炎臨床上並不易區別；惟前者之病程較溫和且預後較佳。
關鍵字
無資料並列摘要
Three premature neonates with a localized perforation of the intestine, but not associated with necrotizing enterocolitis(NEC) or gastrointestinal anomaly are reported. The birth weight of these babies was around 1500g and they exhibited striking similarities in the clinical course. Before laparotomy, NEC was firstly impressed. Abdominal distension, refusal of feedings, poor activity and respiratory distress were the major mantifestations. Pneumoperitoneum was all detected before operation. The perforate site was terminal ileum in one and anterior cecum in the other two babies. The gastrointestinal tract was otherwise normal. The first case received segmental resection of the perforation with end to end anastomosis and the other two underwent ileostomy. Bacteria was discovered from the peritoneal fluid in the second and third cases, including E. coli, Enterobacter cloacae and Klebsiella pneumoniae respectively. The postoperative course was complicated with wound infection and adhesion ileus in two patients. Rectal suction biopsy in the second and third cases showed normal histology. Until present all three patients were uneventful. We concluded that premature or very low birth weight infants with spontaneous, localized gastrointestinal perforation and peritonitis had milder course than NEC, and if promptly diagnosed and treated, the prognosis is excellent.
延伸閱讀
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