Wen Jiabing,Li Yong,Li Ming,et al.Infantile colon stenosis and its immediate follow-up outcomes: an analysis of 7 cases[J].Journal of Clinical Pediatric Surgery,,18():606-610.[doi:10.3969/j.issn.1671-6353.2019.07.017]
Infantile colon stenosis and its immediate follow-up outcomes: an analysis of 7 cases
- Keywords:
- Infant; Colonic Diseases
- CLC:
- R729;R656.9
- Abstract:
- Objective To explore the clinical features,diagnosis and treatment of colonic stenosis in infants and young toddlers and conduct a preliminary analysis of the outcomes of immediate follow-ups.Methods A retrospective analysis was conducted for all operated children with colonic stenosis aged above 3 months from January 2012 to December 2017.A total of 7 cases of infantile colon stenosis were included.There were 5 boys and 2 girls with a median monthly age of 7(3-12) months.The sites of colonic stenosis were ascending colon (n=1),descending colon (n=3) and sigmoid colon (n=3).All children had abdominal distensions of varying degrees and durations.One patient underwent preoperative colonoscopy and another was postoperatively diagnosed by barium enema angiography.One patient was misdiagnosed preoperatively as congenital megacolon and four others underwent emergency exploratory laparotomy because of acute illness.Six cases of colonic stenosis were detected intraoperatively.Stenosis & intestinal anastomosis (n=4) and enterostomy with closure at 3 months (n=2) were performed.One case was missed during an emergency operation.Postoperative abdominal distension became aggravated and enterostomy was performed for sigmoid colonic stenosis.Results One case of enterodenectomy due to missing sigmoid stenosis finally died of multiple organ failure.During a 1-year follow-up period,the remaining 6 patients healed well without any onset of intestinal fistula,adhesive intestinal obstruction or intestinal stenosis.Postoperative pathological results indicated chronic inflammatory changes in stenotic intestinal wall,polypoid hyperplasia of intestinal wall mucosa (n=2),ectopic intestinal mucosal gland formation in stenotic intestinal wall (n=1) and stenosis (n=1).Muscle layer of segmental wall was partially missing and adipose tissue and serosal capillary significantly proliferated.The pathological results of all cases excluded congenital megacolon.Postoperative pathological results showed chronic inflammatory changes in stenotic intestinal wall (n=7),polypoid hyperplasia of intestinal wall mucosa (n=2),ectopic intestinal mucosal gland formation in stenotic intestinal wall (n=1) and stenosis (n=1).Muscle layer of segmental wall was partially missing and adipose tissue and serosal capillary significantly proliferated.The pathological results of all cases excluded the congenital megacolon.Conclusion Rare in infants and young children,colonic stenosis is caused by various inflammatory factors.It is often difficult to diagnose and its misdiagnosis and underdiagnosis have serious consequences.Careful intraoperative observations should be made and the scope of exploration expanded when a problem is not discovered or it fails to explain the disease condition of a child.Colonic stenosis is both safe and feasible for first-stage stenosis and anostomotic resection.However,if multiple intestinal malformations or abdominal inflammation is present,enterostomy is recommended.
References:
1 Vecchia LKD,Grosfeld JL,West KW,et al.Intestinal atresia and stenosis:a 25 year experience with 277 cases[J].Arch Surg,1998,133(5):490-496.
2 Mirza B,Iqbal S,Ijaz L.Colonic atresia and stenosis:our experience[J].J Neonat Surg,2012,1(1):4.
3 Singh V,Pathak M.Congenital neonatal intestinal obstruction:Retrospective analysis at tertiary care hospital[J].J Neonat Surg.2016,5(1):49.DOI:10.21699/jns.v5i4.393.
4 Yeh TC,Chang JH,Kao HA,et al.Necrotizing enterocolitis in infants:clinical outcome and influence on growth and neurodevelopment[J].J Formos Med Assoc,2004,103(10):761-766.
5 Ekema G,Pedersini P,Milianti S,et al.Colonic stricture mimicking Hirschsprung’s disease:a localized cytomegalovirus infection[J].J Pediatr Surg,2006,41(4):850-852.DOI:10.1016/j.jpedsurg.2005.12.029.
6 Marseglia L,Manti S,D’Angelo G,et al.Colonic stenosis post-necrotizing enterocolitis in term newborn with acquired cytomegalovirus infection[J].Chirurgia (Bucur),2015,110(2):175-178.
7 Pelizzo G,Nakib G,Goruppi I,et al.Isolated colon ischemia with norovirus infection in preterm babies:a case series[J].J Med Case Rep,2013,7(1):108.DOI:10.1186/1752-1947-7-108.
8 Xie X,Xiang B,Wu Y,et al.Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis-a case report and literature review[J].BMC Pediatr,2018,18(1):320.DOI:10.1186/s12887-018-1302-9.
9 Pérez Sánchez LE,Hernández Barroso M,Hernández Hernández G.Rectal inflammatory stenosis secondary to Chlamydia trachomatis:a case report[J].Rev Esp Enferm Dig,2017,109(9):668.DOI:10.17235/reed.2017.4917/2017.
10 余克驰,吴晓娟,冯杰雄,等.小儿继发性肠狭窄及闭锁诊疗分析[J].中华小儿外科杂志,2015,(3):211-214.DOI:10.3760/cma.j.issn.0253-3006.2015.03.012.Yu KC,Wu XJ,Feng JX,et al.Analysis of diagnosis and treatment of secondary intestinal stenosis and atresia in children[J].Chinese Journal of Pediatric Surgery,2015,(3):211-214.DOI:10.3760/cma.j.issn.0253-3006.2015.03.012.
11 CH Houben,AW I Lo,SY Tsui,et al.Under pressure:a contribution to the pathogenesis of acquired ileal atresia[J].BMJ Case Reports,2013,2013(now 12,1).DOI:10.1136/bcr-2013-201505.
12 孙建中,王桐德,张立根.婴幼儿先天性结肠狭窄(附3例报告)[J].中华小儿外科杂志,1984,(1):33-34.DOI:10.3760/cma.j.issn.0253-3006.1984.01.015.Sun JZ,Wang TD,Zhang LG.Congenital colonic stenosis in infants and young children:a report of 3 cases[J].Chinese Journal of Pediatric Surgery,1984,(1):33-34.DOI:10.3760/cma.j.issn.0253-3006.1984.01.015.
13 Haxhija Emir Q,Schalamon Johannes,H?llwarth Michael E.Management of isolated and associated colonic atresia[J].Pediatr Surg Int.2011,27(4):411-416.DOI:10.1007/s00383-010-2802-3.
14 Cox SG,Numanoglu A,Millar AJ,et al.Colonic atresia:spectrum of presentation and pitfalls in management.A review of 14 cases[J].Pediatr Surg Int,2005,21(10):813-818.DOI:10.1007/s00383-005-1488-4.
15 彭荣,杨星海,张伊凡,等.先天性肠闭锁352例诊治体会[J].临床小儿外科杂志,2012,(1):45-46.DOI:10.3969/j.issn.1671-6353.2012.01.020.Peng R,Yang XH,Zhang Yifan,et al.Diagnosis and treatment of 352 cases of congenital intestinal atresia[J].Journal of Clinical Pediatric Surgery,2012,(1):45-46.DOI:10.3969/j.issn.1671-6353.2012.01.020.
Memo
收稿日期:2018-5-28。
基金项目:湖南省自然科学基金面上项目（编号：2018JJ2210）
通讯作者:李勇,Email:liyongpuwaike@163.com