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.
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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