儿童继发性结肠套叠临床分析

目的 总结结肠息肉继发结肠套叠的临床特点,指导临床诊治.方法 回顾我院诊治的12例结肠息肉继发结肠套叠临床表现、影像学检查和治疗经过.结果 12例患儿通过超声或CT结合低压空气灌肠得到结肠套叠的诊断并且复位,肠镜的检查证实在套叠部位有息肉.11例在纤维肠镜下作息肉切除,1例开腹手术.结论 继发性结肠套叠的临床症状具有可...     

Imperforate anus with congenital short colon (pouch colon syndrome)

There have not been many case reports of imperforate anus with congenital short colon (pouch colon syndrome). On the Indian subcontinent it is a commonly encountered entity in high ano rectal anomalies. Eighteen cases of pouch colon syndrome were treated in a period of 2 1/2 years, which constituted 26.08% of all high anorectal anomalies. All patients were male and the invertogram was diagnostic in all cases. Associated congenital malformations were common. Most of the patients were in poor general condition at the time of admission. Post-operative pulmonary complications and septicaemia were common. Pouch colostomy was performed in all cases. In the immediate post-operative period 44.44% of all patients died. A pull-through colonorraphy was done as a definitive procedure in 1 case.     

Pilot study on one-stage colonic resection without lavage in obstructed left colon in children in an emergency setting

Classically, left-sided colon obstruction is managed by a multi-staged resection and defunctioning colostomy. The purpose of this study was to examine the feasibility of single-stage resection and anastomosis without intraoperative colonic lavage for acute left-sided colonic obstruction in children. Between October 2000 and May 2006, nine consecutive patients who had a one-stage left-sided colon resection without preceding colonic lavage were evaluated. The main outcome measures were anastomotic leakage, wound infection and death. There were nine patients: six were males and three were females (M:F = 2:1). Their ages ranged from 2–10 years (mean age 6 years). The obstruction was due to irreducible colo-colic intussusceptions in two patients and colo-colic intussusceptions with colonic perforation in four patients, and colo-colic intussusceptions with gangrene in three. All the patients had resection and primary anastomosis without on-table colonic lavage. There were no anastomotic leakages or deaths. Postoperative complications included superficial wound infections in two patients and dry cough in four other patients. Three patients were lost to follow up after 3 years of follow up, but the remaining six are presently doing well. Primary anastomosis without colonic lavage is safe for resection of the left colon in children in an emergency setting.     

Sequestrated tubular duplication of the colon with congenital subglottic stenosis

A 6-year-old male presenting with features of intestinal obstruction because of a sequestrated tubular duplication of the colon is reported. The patient also had congenital subglottic stenosis, an association not yet reported with any type of gut duplication. Complete excision of the duplication was done with preservation of vascularity of the adjacent normal colon. The relevant literature is reviewed briefly. Accepted: 5 October 1998     

Esophageal substitution with colon — the Waterston operation

Twenty-three interpleural (Waterston) colon replacements of the esophagus are reported, 21 for esophageal atresia and 2 for corrosive strictures. Twenty patients are alive with an intact replacement; 17 are swallowing well and 3 have some dysphagia. Two grafts were converted to reverse gastric tubes, 1 for venous infarction and the other because of difficult vascular anatomy. One child died from disseminated intravascular coagulation following gastroenteritis shortly after successful completion of the interposition. Technical details of the operation are described. The need for replacement has been much less in recent years because of improved surgical techniques for esophageal atresia, particularly elective ventilation and the upper pouch flap operation. Recognition that corrosive and reflux strictures, if a dilatable channel can be maintained, will improve if dilatation is persevered with for 2 years may avoid the need for replacement.     

Reduced distribution of pacemaking cells in dilated colon

Interstitial cells of Cajal (ICC) act as pacemaker in gastrointestinal smooth muscle. In animals, small bowel dilatation produces a reduction in ICC numbers and in pacemaker function. With resolution of dilatation, ICC numbers and pacemaking function are partially restored. In human colonic disease states, dilatation is associated with dysmotility. The effect of dilatation on ICC distribution has not previously been examined in the human colon. Tissues from a neonate with colonic atresia and a 17-year-old adolescent with acquired megasigmoid were fixed, sectioned and incubated with anti cKit antibodies followed by fluorescent secondary antibodies. Distended and non-distended segments of colon were examined for ICC distribution using immunohistochemistry to c-Kit. Images were obtained with confocal microscopy. In both patients, there was a marked reduction in cKit-immunoreactive cells in the circular muscle and the myenteric plexus of the distended colon compared to the distal non-distended colon. Dilatation of the human colon is associated with a marked reduction in ICC. A resulting loss of pacemaker function could contribute to dysmotility associated with distension. Further studies assessing pacemaking function in human subjects and investigating reversibility of ICC disruption may allow new therapeutic strategies.     

An unusual complication of retrosternal colon interposition successfully managed by median sternotomy and revision retrosternal pull-through

An unusual complication of a retro-sternal colonic interposition is described where the redundant retro-sternal section of the graft underwent mesenterico-axial volvulus and infarction 3.5 years after the initial procedure. Access to the graft was obtained via a median sternotomy. At a second procedure the residual distal colon was used to reconstitute the interposition graft via the retro-sternal route without a repeat sternotomy with an excellent outcome. Graft redundancy is an avoidable complication of colon interposition provided certain technical steps in the operation are adhered to. Median sternotomy afforded safe access to the retro-sternal problem with good healing and long-term outcome. Accepted: 4 August 2000     

Segmental vascular occlusion of the colon

Segmental vascular occlusion of the colon is a rare, quite commonly reversible condition, so far recorded only in adults. The present report deals with two pediatric patients displaying clinical and radiological findings consistent with this entiry. A benign course of disease with rapidly subsiding manifestations support our interpretation. The etiology remains obscure.     

Contrast enema demonstration of a colon cut-off sign in a baby with perforated appendicitis

An abrupt demarcation between a narrow ascending colon and the transverse colon is a plain film finding that may be seen in the patient with acute perforation of the appendix. In an infant, contrast enema may demonstrate this sign when it is not apparent on the plain film.     

Double-contrast enemas in children: The “knee-chest” view of the rectosigmoid colon

A modified prone lateral projection of the rectosigmoid colon with horizontal beam is described for double-contrast barium enemas in children. Elevation of the buttocks allows barium to drain retrograde from the air-filled rectum, improving visualization in selected patients.Disclaimer: The opinions or assertions contained herein are the private views of the author and are not to be construed as reflecting the views of the Departments of the Army or Defense     

Congenital segmental dilatation of the colon: report of a case and review of the literature

Segmental dilatation of the colon is a rare lesion. A patient with this lesion complicated by chronic constipation from birth is described. Although the clinical picture and radiographic studies are indistinguishable from Hirschsprung's disease, anorectal manometric studies and a rectal mucosal biopsy are of paramount importance for the diagnosis of this condition. This disease can be cured by resection of the dilated segment. Offprint requests to: N. Komi     

Survivin siRNA纳米脂质体体内抗结肠癌活性研究

目的观察Survivin siRNA纳米脂质体对裸鼠结肠癌种植瘤Survivin基因表达以及肿瘤生长的影响。方法利用结肠癌细胞LOVO细胞株构建动物模型,将脂质体包裹的Survivin siRNA经静脉注入裸鼠种植瘤体内,以无关siRNA为对照组,观察动物及瘤体的变化,RT-PCR法检测瘤组织Survivin mRNA水平,Western blot法检测瘤组织survivin蛋白表达情况。结果 Survivin siRNA注射组(SU-IV组)在注射10剂后肿瘤体积较对照组明显缩小,差异有显著性(P0.05)。SU-IV组Survivin mRNA及蛋白表达水平低于对照组(P0.001)。结论 Survivin siRNA纳米脂质体能抑制裸鼠结肠癌种植瘤的生长,注射Survivin siRNA纳米脂质体后肿瘤组织Survivin mRNA及蛋白表达下调。     

Non-traumatic colon perforation in children: a 10-year review

Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 ± 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.     

Cultured urothelium in sheep bladder augmentation

In search of alternatives for urothelial-lined augmentation or reconstruction of the urinary bladder, this study combined the application of seromuscular gastrointestinal (GI) segments with the use of in-vitro cultured, autologous urothelial cells in a sheep model. A cell culture system was set up for establishment and expansion of urothelial cells out of small biopsies from bladder mucosa. A biodegradable carrier made of lactidcaprolactoncopolymer was introduced, allowing upside-down transplantation of cell cultures in vivo. Bladder mucosal biopsies were taken from 14 sheep (mean weight 13.3 kg) with an average yield of 3.5×10⁵ viable cells/cm² after trypsinization. Primary low-density cultures grew to confluence within 5–7 days. Secondary cultures were established on the biodegradable film and were available a week later. They were transplanted onto demucosalized segments of stomach (group 1) or colon (group 2) in 5 animals each, followed by bladder incorporation in clam fashion. The earliest specimens, demonstrating survival and some proliferation of the cultured urothelium in both groups, were obtained 13 days postoperatively. To exclude urothelial regrowth, a temporary pouch grafted with cultured urothelium was created in 2 more sheep of each group. Biopsies were taken after 2 and 3 weeks, respectively, when the reopened pouch was integrated into the bladder (delayed augmentation). In these pouches, adherence and proliferation of urothelial cells could not be demonstrated. Limited radiologic and urodynamic investigations after 5–6-month follow-up revealed good shape, capacity, and compliance of the primarily augmented bladders only. The results indicate that urothelial cell cultures can be established and applied in vivo. Despite upside-down transplantation, they are able to survive on seromuscular segments in an autologous setting. The bladder environment is necessary to promote complete covering of the seromuscular segments. Based on our histologic findings, the share of both resident bladder urothelium and transplanted cells in the formation of the final urothelial lining remains uncertain. Morphologic and urodynamic follow-up data indicate that this process can be accelerated by the transplanted urothelial cells, reducing fibrotic changes of the GI segments. The functional quality of the augmented bladder seemed to improve compared to results after seromuscular augmentation alone.     

Volvulus of the ascending colon: An unusual complication of non-rotation of the midgut

A case of non-rotation of the bowel is presented wherein volvulus of the colon occurred causing acute obstruction. Spontaneous reduction following a barium enema as well as the patient's history leads us to suspect that volvulus had occurred in the past and was responsible for the intermittent nature of the patient's symptoms. This type of volvulus is distinctly different from midgut volvulus and is a rare complication of the anomaly of intestinal rotation and fixation known as non-rotation of the bowel. Efforts should be made to study patients with malrotation anomalies at a time when they are acutely symptomatic so that intermittent volvulus such as shown here is not overlooked.     

肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用

目的报告逼尿肌切开双层肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用.方法1986～1999年间治疗脊髓发育不良所致的反射亢进性神经原性膀胱52例(年龄4～18岁),通过随访比较手术前后临床表现和尿流动力学检查,评价其疗效.结果 43例随访3个月～13年,平均6.7年.术前均表现为尿失禁;术后均无粘液尿、电解质失衡、代谢紊乱、尿路结石等,24例(55.8%)能完全自主排尿,15例(34.9%)配合CIC可达到不失禁,有效率达到90.7%(39/43).39例手术前后行尿流动力学检查,其术前膀胱容量为(159±78)ml,膀胱容量差为(-145±67)ml,充盈期末逼尿肌压为(6.5±2.6)kPa;术后分别改变为(346±86)ml、(12±52)ml、(2.1±1.5)kPa.均较术前有显著改善(P<0.01),已达到或接近其正常范围.结论逼尿肌切开双层浆肌层膀胱扩大术是一种较理想的膀胱扩大术和反射亢进性神经性膀胱的有效疗法.     

Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature

BACKGROUNDChilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.CASE SUMMARYHere we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress. He was treated conservatively but the symptoms persisted requiring a surgical approach. While there have been several cases of Chilaiditi syndrome reported in adults, there is a scarcity of cases reported in the pediatric population. Our review of the literature found only 30 pediatric cases, including our reported case, with Chilaiditi syndrome, 19 (63%) of which were male. The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years. In our review, we found that the most common predisposing factors in children are aerophagia (12/30 cases) and constipation (13/30 cases). Ninety percent of the cases presented with complete intestinal interposition, in 100% of which, the colon was involved. Three of the 30 cases were associated with volvulus.CONCLUSIONIn the pediatric population, conservative (21/30 cases) and surgical (8/30 cases) treatment approaches have produced satisfactory outcomes for all the patients, regardless of approach.     

Symptoms,diagnosis, and therapy of neuronal intestinal dysplasia masked by Hirschsprung's disease

Twenty-four cases of concomitant Hirschsprung's disease (HD) and neuronal intestinal dysplasia (NID) are presented. The clinical picture is characterized by the early and acute onset of HD symptoms. The diagnosis is established by means of rectal and colonic biopsies. Open biopsies during laparotomy should be taken without injury to the mucosa. Early surgical therapy consists of extended resection of the aganglionic segment and the colon affected by NID up to the splenic flexure. Complications are imminent if the aganglionosis masks the symptoms of NID and, accordingly, only the aganglionic segment is resected. As an alternative, postponed resection of the aganglionic segment alone is proposed once the NID-affected bowel develops functional maturation. In children who do not show an improvement of colon dysmotility, however, extended resection is recommended at the age of 4 years. In follow-up studies of colon motility, functional colon sonography is used.Offprint requests to:} G. Pistor     

Neuronal intestinal dysplasia

Findings in 23 children with neuronal intestinal dysplasia (NID) are presented. Twelve children had Hirschsprung's disease that masked the existence of proximal NID. In all cases the diagnosis was established by histological-histochemical examination. Amelioration of symptoms by conservative treatment alone was achieved in 4 children; in 13 cases colostomy was necessary. In 6 patients colon resection was performed: 2 suffered from both colitis and obstruction; the other 4 were treated for obstruction, multiple perforations, persistant adynamia of the left colon, and fistulation. In 9 patients the colostomy was closed. Four of 6 children who did not have sonographic confirmation of motility had complications due to colon dysmotility after closure of their normally functioning colostomy. Therapeutic measures are based exclusively on clinical and functional parameters. The clinical picture dictates the emergency measures (colostomy, colon resection, and colectomy). Normal colostomy function is not a sufficient criterion of normal colon motility. Functional sonography of the colon is included in the planning of further therapy. Indications, timing, and extent of colon resection can be reliably determined using the sonographic method. Offprint requests to: G. Pistor     

Colonic atresia: spectrum of presentation and pitfalls in management. A review of 14 cases

Fourteen cases of colonic atresia seen over a 38-year period are reviewed with particular reference to clinical presentation and pitfalls in management. Seven had Type I atresia, two Type II and five Type IIIa. Ten had associated gastrointestinal anomalies. Management varied considerably. Six had primary colonic anastomosis. Two of these developed complications due to unrecognized distal hypoganglionosis, two had associated jejunal atresias resulting in short bowel syndrome, and two had primary anastomosis protected by proximal ileostomies. Seven had a staged repair with initial defunctioning enterostomy with only one complication, an unfixed mesentery that later resulted in midgut volvulus. The only mortality was a patient in which a jejunal atresia repair leaked as a result of a missed colonic atresia. Operative strategy should depend on the clinical state of the patients, the level of atresia, associated small bowel pathology and exclusion of distal pathology. Primary anastomosis would only rarely be advised with a circumspect approach. Long-term outlook, as in small bowel atresia is generally excellent. An erratum to this article can be found at