高频彩超及全控式水压复位器诊治幼儿肠套叠

目的总结彩超下水灌肠诊治急性肠套叠的经验。方法采用高频超声定位并诊断肠套叠,用彩色多谱勒显像（CDFI）确定套叠部血流动力学改变,判断是否适宜灌肠复位,并用自制全控式水压复位器于高频彩超监测下灌肠复位。同期设立临床诊断70例肠套叠患儿为对照组,经低频（3．5MHz）B超诊断、监测并分次注水灌肠复位。结果72例拟诊幼儿肠套叠病例中明确诊断68例,判断不宜灌肠3例（经手术证实为难复性肠套叠,肠缺血严重。65例以全控式水压复位器于高频彩超监测下灌肠复位全部成功。对照组70例临床诊断幼儿肠套叠病例在低频B超监测下分次注水灌肠复位治疗56例,44例成功。结论全控式水压复位器结合高频彩超治疗幼儿肠套叠较之低频B超分次注水复位法,指征更明确,治疗更安全快速,效果更好,便于基层医院推广。     

B超引导下改良水压灌肠治疗小儿肠套叠

分析Ｂ超引导下改良水压灌肠治疗小儿肠套叠的疗效，介绍使用方法和意义。本组为１６８例小儿肠套叠，男１３０例，女３８例，全部采用Ｂ超引导下改良水压灌肠法治疗。灌肠特点是以自制密闭式手控加压灌肠器连接直径为０．６～０．８ｃｍ的肛管进行。１６８例患儿中，１５４例（９１．７％）为回结型肠套叠，１０３例病程不满４８小时。小儿的年龄为２．５月～４岁。１６１例复位成功，治愈率９５．８％（１６１／１６８）。７例非回结型套叠复位失败。我们认为，本灌肠技术简易、安全可靠。使用这种技术，监测压力方便，疗效满意。     

Intussusception en W

An unusual case of intussusception is reported in which two parallel loops of small intestine had intussuscepted into a third distal loop. The similarity to Maydl's hernia led to the term intussusception en W. Review of the available literature failed to reveal any previous report of such a case.     

Intussusception

In the previous two parts of this review on intussusception, the diagnosis and management of symptomatic, idiopathic ileocolic and ileoileocolic intussusceptions, which are considered to result from hyperplasia of lymphoid tissue in the distal ileum, were discussed. In this third part, those intussusceptions with an identifiable cause including pathologic lead point, those due to gastrojejunostomy or other feeding tubes, and those that are seen in the postoperative period as well as those that may be asymptomatic or may reduce spontaneously (usually limited to the small bowel) are discussed.     

肠套叠免疫反应变化在临床治疗中的指导意义

目的探讨肠套叠免疫疗法的可行性。方法选择我院自2002年以来经本院治疗的肠套叠患儿96例,进行血清Ig类、粪便sIgA测定,检测数据均以均数±标准差表示,组间比较采用t检验,并得出结论。结果研究组血清IgA、IgM较正常对照组明显减少,差异有统计学意义。IgG与对照组无显著性差异。研究组中急性期sIgA较恢复期及对照组均明显减少,差异有统计学意义。恢复期sIgA较急性期及对照组明显增加,差异有统计学意义。结论临床治疗中,当解除肠套叠的梗阻状态后,除抗感染、维持水、电解质和酸碱平衡等传统疗法外,适当给予免疫治疗,可能会有效中和病原体,缩短病程。同时对于婴幼儿加强其免疫机能,可能会减少肠套叠的发生机率。     

Intussusception: effectiveness of gas enema

In tertiary paediatric centres, gas enema reduction of intussusception appears to be more effective and perhaps safer than barium enema reduction. Despite the higher success rate of reduction when gas is used, there remain some patients in whom the technique fails but who at operation have an intussusception that theoretically should have been reducible with the gas enema: easy to reduce manually, no necrosis of the bowel, and no pathological lesion at the leadpoint. After a gas enema failed, manual reduction of an intussusception was achieved in 41 of 49 patients and was difficult in less than one-half. It is suggested that a significant proportion might have been reducible had the technique of gas reduction been modified, either by repeating the enema some hours after the first attempt or by using higher insufflation pressures. In practice, clinical features were not useful in predicting in which patients gas enema would be unsuccessful or whether operative reduction would be successful without resection.     

Intussusception associated with Yersinia pseudotuberculosis infection

Intussusception associated with Yersinia pseudotuberculosis infection was developed in three boys; two of them had a history of drinking untreated water. All intussusceptions were localized at the ileocolic region, and all patients completely recovered with Gastrografin^R enema and supportive treatment without complication and operation.     

Intussusception: the paediatric radiologist's perspective

The diagnosis and treatment of idiopathic intussusception of childhood have changed over the last 10 years. Current diagnostic techniques include plain radiographs and ultrasonography. The standard treatment in the absence of peritonitis or free intra-abdominal air is gas enema, followed by surgical intervention if the intussusception remains irreducible. This review, by radiologists for surgeons, describes the current role of imaging in the diagnosis and management of intussusception.     

Intussusception mimicking rectal prolapse

We report a 10-week-old boy with a prolapsing colocolic intussusception mimicking rectal prolapse. Rectal prolapse of ileocolic intussusception has been well-described, but colocolic intussusception presenting as rectal prolapse is unique.     

Intussusception nephrosis and Drash syndrome

A 6-month-old female infant presented with intussusception. Post-operatively she was noted to have nephrotic syndrome. The oedematous bowel wall may have been the cause of the intussusception and this has not been previously described. In addition her karyotype was XY suggesting her nephropathy was associated with Drash syndrome.     

小儿肠套叠与肠道病毒感染

采用逆转录聚合酶链式反应分别对原发性肠套叠患儿和健康小儿的粪便标本进行肠道病毒核糖核酸（ＲＮＡ）检测，结果４岁以上年龄组两者肠道病毒阳性率差异无显著性意义（Ｐ＞０．０５），４岁以下年龄组原发性肠套叠肠道病毒阳性率３７．０４％，显著高于健康小儿阳性率１１．１１％（Ｐ＜０．０１），提示肠道病毒感染可能是部分原发性肠套叠的病因之一。     

2037例小儿急性肠套叠的诊治体会

目的 对小儿急性肠套叠病例的临床特点、诊断和空气灌肠治疗方法进行探讨。方法 分析总结2037例小儿急性肠套叠的临床表现和X线下空气灌肠复位的诊治效果。结果 2037例均以肠套叠四大症状(阵发性哭闹、呕吐、血便和腹部包块)中两个或以上为主要表现,X线监视下低压空气灌肠诊断、空气灌肠治疗和手法推挤按摩整复成功1972例,成功率为96．8％,未复位65例(占3．2％)。穿孔2例(占0．98‰)。结论 早期正确诊断、空气灌肠及手法按摩整复治疗明显提高小儿急性肠套叠整复率;空气灌肠是肠套叠诊疗的首选方法。     

Intussusception as a late morbidity after gastroschisis repair

A 4-month-old boy presented with intussusception following primary closure of a gastroschisis as a neonate. Hydrostatic reduction of the intussusception was successful. After the reduction an ileus persisted for several days, but was successfully managed conservatively. As far as we know, this is the first report of a gastroschisis patient developing an intussusception. The diagnosis of intussusception per se was not difficult, but itwas difficult to rule out a midgut volvulus, which would have required an urgent laparotomy.Presented at the New Zealand Annual Scientific Meeting of Royal Australasian College of Surgeons, Palmerston North, August 10, 1994     

Intussusception: recurrence following gas (oxygen) enema reduction

Over a 38-month period, prospective data were collected on all episodes of intussusception treated at the Royal Children's Hospital, Melbourne. There were 170 initial episodes for which a gas enema was performed, 127 of which were reduced successfully. Recurence occured in 10 patients following initial successful gas enema reduction, a recurrence rate of 7.9%, which compares with a recurrence rate of 8.9% with barium (P = 0.896). We conclude that the gas enema does not have a higher rate of recurrence than barium and that there is no evidence of a significant incidence of incomplete reduction unrecognised at the time of gas enema. Correspondence to: S. W. Beasley     

Intussusception

Intussusception is the most common cause of intestinal obstruction in infancy and early childhood. It occurs when one segment of bowel (the intussusceptum) invaginates into an adjacent distal segment of bowel (the intussuscepien). The classical presentation is with intermittent abdominal pain, vomiting and redcurrant jelly-like stool. Diagnosis can be accurately confirmed with an ultrasound scan. Initial management is with fluid resuscitation and antibiotics. Following adequate resuscitation, treatment is usually with a non-operative air enema reduction under fluoroscopic guidance. If this fails to completely reduce the intussusception, the air enema may be repeated in patients that are clinically stable. The main risks associated with an air enema are bowel perforation, failed reduction and recurrence. Surgical intervention is indicated in patients presenting with perforation, those that are clinically unstable or where multiple air enemas have failed to reduce the intussusception. Surgery can be performed open or laparoscopic and involves attempted manual reduction of the intussusception and may require bowel resection and anastomosis.     

Intussusception in children: 11-year experience in Vladivostok

Idiopathic intussusception is an important abdominal emergency in infancy and childhood. The nonoperative management by air enema has always been the standard of care in Russia. Our purpose is to assess our reduction rate and the rate of complications. We performed a retrospective analysis of all intussusception cases seen at the Department of Paediatric Surgery from 1994 to 2005. The data obtained included age, sex, clinical presentation, diagnostic procedures, mode of treatment, and results. Patients included 280 children from 1 month to 14 years of age. Eighty-one percent of children were under age 1 year old, 61% were boys. The duration of symptoms before treatment was less than 18 h in 65%, 18–24 h in 21%, and more than 24 h in 14% of patients. The successful reduction rate was 86.1%. One patient with a duration of symptoms more than 24 h experienced colon perforation. Thirty-nine patients underwent surgery and, among these, abnormalities in the intestinal wall required resection in 12 cases. An association between the duration of symptoms and the outcome of the non-surgical treatment was present; non-surgical reduction was successful in 97.3% in the group with the duration of symptoms less than 18 h, 86.4% in 12–24 h, and 33.3% in more than 24 h. Air enema is a safe and effective approach for uncomplicated intussusception reduction with a high success rate, but the duration of symptoms directly increases the complication rate.     

Intussusception in preterm infants: case report and literature review

Intussusception is an extremely rare disorder in preterm infants. An infant of 29 weeks gestational age with this condition is reported and a retrospective analysis of 17 previously reported cases presented. In the reviewed preterm infants, risk factors for intussusception seemed to be multifactorial. Clinical features included severe abdominal distension (17/17), gastric aspirates (13/17), commonly bilious, bloody stools (10/17) and rarely a palpable abdominal mass (5/17). Diagnostic features were signs of small bowel obstruction on the abdominal radiographs. Signs and symptoms were similar to those seen in necrotizing enterocolitis, therefore difficulties in establishing a correct diagnosis led to an average delay of 7 days between the onset of symptoms and abdominal surgery, increasing the risk of developing a compromised bowel. Conclusion The differential diagnosis of an intussusception should be considered in preterm infants with acute abdominal distension and tenderness. Received: 7 September 1998 / Accepted in revised form: 17 March 1999     

Intrauterine Intussusception and Ileal Atresia Presenting as Acute Perforation

ABSTRACT. A case is reported of a girl born by caesarean section at 28 weeks gestation who developed an acute perforation of the ileum due to intussusception 11 days after birth. This was treated successfully by resection of the affected segment of ileum and by performing a temporary ileostomy followed by end-to-end anastomosis. She made a complete recovery. This case also demonstrates the difficulty of early diagnosis of intussusception in the neonatal period.     

Sonographic diagnosis of intestinal polyps in children

Although colonoscopy is the modality of choice for the diagnosis of intestinal polyps, sonography may be the first diagnostic modality in the evaluation of children with this pathology. Graded compression sonography of the small and large bowel may be useful in diagnosing intestinal polyps. A specific diagnosis is possible in many cases as most polyps have a characteristic appearance. Although sonography is not intended to replace endoscopy in the diagnostic work-up of intestinal polyps, it is important for radiologists to be aware of this appearance as they can be the first in making the diagnosis of intestinal polyps using sonography. This paper was presented at the 44th Annual Meeting of the European Society of Pediatric Radiology, Barcelona, Spain, June 2007.     

Intussusception of vitello-intestinal tract through an exomphalos in trisomy 13

Intussusception of a patent vitello-intestinal tract through the dome of an exomphalos is extremely rare, but appears to have an association with trisomy 13. It can be distinguished from a ruptured exomphalos by: (1) its single limb (no loop of bowel); (2) its mucosal surface; and (3) an opening at its end.Offprint requests to: S. W. Beasley