Gui Linling,Yu Lei,Lu Wei,et al.Relative factors analysis for gastric perforation or intestinal necrosis in congenital intestinal malrotation[J].Journal of Clinical Pediatric Surgery,,21():69-73.[doi:10.3760/cma.j.cn.101785-202101007-013]
Relative factors analysis for gastric perforation or intestinal necrosis in congenital intestinal malrotation
- Keywords:
- Congenital Intestinal Malrotation/CO; Intestinal Volvulus; Gastric perforation; Intestinal Necrosis; Infant; Newborn
- Abstract:
- Objective To explore the relative-factors of congenital intestinal malrotation (CIM) with gastric perforation and intestinal necrosis and explore the operative intervention factors in neonates. Methods Between January 2012 and December 2019, a retrospective study was performed for 216 CIM neonates.Risk factors were identified by univariate and multivariate analyses.Clinical and laboratory parameters included gender, age, birth weight, gestational age, onset time, bilious emesis, bloody stool, abdominal distension, total protein, albumin, hemoglobin and C-reactive protein (CRP). Results There were 19 boys and 6 girls with a surgically confirmed diagnosis of CIM with gastric perforation or intestinal necrosis.In univariate analysis, warning signs for gastric perforation or intestinal necrosis were non-bilious emesis, short onset time, bloody stool, abdominal distension, low level of total protein, albumin, hemoglobin and elevated CRP (P<0.05).Multivariate Logistic regression analysis revealed that independent predictive factors were anemia, abdominal distension and elevated CRP (OR values 0.96, 0.01, 1.05 respectively, P<0.05).Serum CRP level >16.4 mg/L had a sensitivity of 76.0% and a specificity of 94.6% for gastrointestinal perforation and necrosis in CIM, Area under the receiver operating characteristic (ROC) curve was 0.89 (P=0.00). Conclusion CIM with volvulus may lead to such serious complications as gastric perforation and intestinal necrosis.The more advanced degree of midgut volvulus, the higher probability of causing volvulus necrosis.Specific clinical manifestations and laboratory parameters are helpful in the identification of gastric perforation and intestinal necrosis in CIM neonates and surgical exploration should be performed as soon as possible.
References:
[1] Langer JC.Intestinal rotation abnormalities and midgut volvulus[J].Surg Clin North Am,2017,97(1):147-159.DOI:10.1016/j.suc.2016.08.011.
[2] Isani MA,Schlieve C,Jackson J,et al.Is less more?Laparoscopic versus open Ladd’s procedure in children with malrotation[J].J Surg Res,2018,229:351-356.DOI:10.1016/j.jss.2018.04.016.
[3] 周小渔.Ladd手术治疗先天性肠旋转不良[J].临床小儿外科杂志,2009,8(4):64-65.DOI:10.3969/j.issn.1671-6353.2009.04.022. Zhou XY.Ladd’s surgery treatment of congenital intestinal malrotation[J].J Clin Ped Sur,2009,8(4):64-65.DOI:10.3969/j.issn.1671-6353.2009.04.022.
[4] Karaman ?,Karaman A,??nar HG,et al.Is color Doppler a reliable method for the diagnosis of malrotation?[J].J Med Ultrason,2018,45(1):59-64.DOI:10.1007/s10396-017-0794-5.
[5] Hosokawa T,Hosokawa M,Tanami Y,et al.Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus[J].J Ultrasound Med,2020,39(4):683-692.DOI:10.1002/jum.15145.
[6] Zhang W,Sun H,Luo F.The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation[J].Medicine (Baltimore),2017,96(42):e8287.DOI:10.1097/MD.0000000000008287.
[7] Hong CR,Han SM,Staffa SJ,et al.Long-term outcomes of ultrashort bowel syndrome due to malrotation with midgut volvulus managed at an interdisciplinary pediatric intestinal rehabilitation center[J].J Pediatr Surg,2019,54(5):964-967.DOI:10.1016/j.jpedsurg.2019.01.025.
[8] Wales PW,Jancelewicz T,Romao RL,et al.Delayed primary serial transverse enteroplasty as a novel management strategy for infants with congenital ultra-short bowel syndrome[J].J Pediatr Surg,2013,48(5):993-999.DOI:10.1016/j.jpedsurg.2013.02.015.
[9] Yang T,Huang Y,Li J,et al.Neonatal gastric perforation:case series and literature review[J].World J Surg,2018,42(8):2668-2673.DOI:10.1007/s00268-018-4509-x.
[10] 林素,林振浪.先天性胃壁肌层缺损致新生儿胃穿孔12例临床分析[J].中国新生儿科杂志,2016,31(1):55-57.DOI:10.3969/j.issn.1673-6710.2016.01.015. Lin S,Lin ZL.Clinical analysis of neonatal gastric perforation with congenital gastric muscular wall defects:a report of 12 cases[J].Chin J of Neonatal,2016,31(1):55-57.DOI:10.3969/j.issn.1673-6710.2016.01.015.
[11] Yang CY,Lien R,Fu RH,et al.Prognostic factors and concomitant anomalies in neonatal gastric perforation[J].J Pediatr Surg,2015,50(8):1278-1282.DOI:10.1016/j.jpedsurg.2015.04.007.
[12] Goel P,Bajpai M,Nagendla MK,et al.Gastric deserosalization:what lies behind closed doors[J].J Indian Assoc Pediatr Surg,2018,23(4):216-218.DOI:10.4103/jiaps.JIAPS_78_17.
[13] Horsch S,Albayrak B,Tr bs RB,et al.Volvulus in term and preterm infants-clinical presentation and outcome[J].Acta Paediatr,2016,105(6):623-627.DOI:10.1111/apa.13403.
[14] Lin YP,Lee J,Chao HC,et al.Risk factors for intestinal gangrene in children with small-bowel volvulus[J].J Pediatr Gastroenterol Nutr,2011,53(4):417-422.DOI:10.1097/MPG.0b013e3182201a7.
Memo
收稿日期:2021-01-17。
基金项目:武汉市卫生和计划生育委员会科研项目（WX17C15）
通讯作者:余雷,Email:yulei20060628@163.com