不完全川崎病致急性肾衰竭一例

川崎病(Kawasaki disease,KD)又称皮肤黏膜淋巴结综合征,是一种免疫介导的全身性血管炎.KD致肾衰竭罕见,现报道1例不完全川崎病致急性肾衰竭. 患儿,男,5岁11月.因发热7 d,阵发性腹痛伴左下肢痛、少尿3 d,于2008年12月12日入院.无传染病史,无家族史,无药物过敏及中毒史.1 d前当地查Scr 544.9μmol/L,BUN 36.4 mmol/L,拟诊急性肾衰竭,转我院.体检:BP 126/83 mm Hg,双肾叩击痛阳性,双下肢轻度水肿,左髋膝关节、左大腿压痛,左髋关节活动受限,余无特殊.     

Two surgical procedures for strictures at Finney strictureplasty for small bowel Crohn's disease

In patients with Crohn's disease, long small bowel strictures are sometimes treated by a Finney strictureplasty. Strictures at an entrance and exit of a previous Finney strictureplasty are associated with severe obstructive symptoms and sometimes blind loop syndrome. Those strictures are difficult to manage. We herein introduce two different surgical procedures: one is a continuous T-shaped strictureplasty and the other is anastomosis between the Finney pouch and the divided small bowel. Both procedures immediately relieved obstructive symptoms and required no major resection of the bowel. After a 2-year follow-up, there has been no recurrence at the previous Finney strictureplasty.     

Multiple idiopathic small bowel strictures: report of three cases.

Multiple strictures of the small bowel are relatively rare. In many cases, a distinct cause can be defined, but some strictures are unexplainable by any specific mechanism and have been termed 'idiopathic' small bowel strictures. We present 3 cases of multiple small bowel strictures in which the affected segments were studied with perioperative photoplethysmography, in vivo specimen angiography and pathology. Neither photoplethysmographic alterations nor structural vascular lesions were found.     

Ischemic necrosis of small bowel following laparoscopic surgery.

BACKGROUND AND OBJECTIVE: Small bowel ischemia following laparoscopy was described recently as a rare fatal complication of the CO2 pneumoperitoneum. Of the 8 cases reported in the surgical literature, 7 were fatal, 1 was not. In this report, we describe the first gynecological case. METHODS: A 34-year-old woman who underwent laparoscopy with extensive adhesiolysis and myolysis was re-admitted with an acute abdomen on postoperative day 4. Immediate laparotomy revealed acute peritonitis, extensive adhesions, and a 3-cm defect in the small bowel. Tissue examination showed ischemic necrosis of edematous, but essentially normal, bowel mucosa. The postoperative course was extremely complicated. She was discharged after a 2-month hospital stay in the intensive care unit for rehabilitation. RESULTS: Data are available on 7 patients (including ours). All procedures were described as uneventful. The intraabdominal pressure was set at 15 mm Hg when specified. Some abdominal pain occurred in all, nausea and vomiting in 4, diarrhea in 2, abdominal distention in 1, fever in none. Quick reintervention laparotomy was performed in 2 and delayed in 5 (up to 4 days). DISCUSSION: The CO2 pneumoperitoneum is a predisposing factor for intestinal ischemia as it reduces cardiac output and splanchnic blood flow. However, critical ischemia relies on underlying vasculopathy or an inciting event. CONCLUSION: Patient selection, maintaining intraabdominal pressure at 15 mm Hg or less, and intermittent decompression of the gas represent the best options for preventing this complication.     

不完全性川崎病的早期诊断（附32例报告）

川崎病（KD）又称皮肤粘膜淋巴结综合征,是一种以全身血管炎为主要病变的急性发热出疹性小儿疾病。现将本院2002年1月至2008年5月收治的32例不完全性川崎病分析总结报告如下。     

Leiomyoma of small bowel: a case report.

Benign small bowel tumors are rare and usually present in late adult life. Because of its raity, a case of benign leiomyoma of the small bowel presenting with distal small bowel obstruction in childhood is reported, with a discussion of the principles of management.     

Jejunal diverticular disease with unborn enterolith presenting as a small bowel obstruction: a case report

Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. An interesting case of an unborn enterolith (enclosed calculus) from a jejunal diverticulum presenting as a small bowel obstruction is presented. The patient is a 66-year- old woman with no prior history of abdominal surgery who presented with a high-grade bowel obstruction. CT with intravenous barium contrast confirmed the presence of a transition point from dilated to decompressed small bowel in the mid jejunum. At laparotomy, a freely mobile mass was found in this area leading to the bowel obstruction. The mass was removed by making a small enterotomy in the jejunum. While running the small bowel proximally, a small segment of jejunum, approximately 8 cm, containing several diverticuli was found. This bowel obstruction was the result of an unborn enterolith from this segment of bowel. The patient's hospitalization was benign and she was discharged home on postoperative day 4.     

Total small bowel strangulation: a case report.

A case of strangulation of the entire small intestine caused by an internal incarcerated hernia is presented. At laparotomy the small intestine was severely discoloured, paralytic and the viability of the bowel was questionable. No resection was performed. At a second laparotomy 10 h later the intestine was hyperaemic and exhibited lively motor activity. Recovery was complete. The importance of prolonged conservative management in avoiding extensive resection is stressed.     

Crohn's disease of the small bowel

Crohn's disease of the small bowel frequently requires surgical intervention. While dealing with the disease complications that require intervention, treatment should be based on a long-term strategic plan that recognizes the likelihood of recurrent disease, repeat surgeries, and the possibility of a future ostomy. Resection forms the basis for surgical treatments, but strictureplasty, abscess drainage, intestinal and diversion bypasses also are used, selectively.     

A case of perforated small bowel adenocarcinoma as first symptom of Crohn's disease

A case of perforated small bowel adenocarcinoma presenting as first symptom of Crohn's disease is reported in a 53 years old male patient with abdominal pain and alteration of bowel habits. Endoscopic bioptical sampling demonstrated a Crohn's disease in active stage. The patient underwent medical therapy with resolution of the complained symptomatology; 20 days after discharge the patients is rehospitalized for acute abdomen. A narrowing perforated neoplasia in terminal ileum was discovered at laparotomy. Diffuse peritonitis and metastatic peritoneal implantations were also revealed. An ileocolic resection is performed with ileo-transverse colon anastomosis. The patient dies 4 months later for advanced disease.     

Small bowel obstruction secondary to incomplete removal of a ventriculoperitoneal shunt: case report

Small bowel obstruction and partial enteral loss secondary to entrapment by an incompletely removed ventriculoperitoneal shunt is a previously unreported hazard.     

Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients

ObjectivesTo compare the clinical and laboratory features and the rate of echocardiographic coronary artery abnormalities in patients with complete and incomplete forms of Kawasaki disease (KD) and to determine which additional clinical criteria might support a suspicion of KD.MethodsWe retrospectively reviewed the medical records of patients with KD who were admitted to the general pediatrics department of the Kremlin Bicêtre Teaching Hospital, France, between January 1995 and May 2006. We compared patients with a fever and four or five of the principal criteria (complete KD) to the other patients (incomplete KD). Clinical and laboratory features were abstracted from the records.ResultsWe identified 63 patients with a mean age of 33 months (± 31). The male-to-female ratio was 2.47. Four patients were excluded. Of the remaining 59 patients, 39 had complete KD and 20 incomplete KD. The group with complete KD had significantly higher rates of changes in the extremities, conjunctival injection, exanthem, and enanthem; and a significantly lower rate of coronary artery dilation (48.7% vs. 90% in the incomplete KD group, P = 0.002). Serum levels of alanine aminotransferase and gamma glutamyl transferase were significantly higher in the complete KD group. No significant differences were found between the two groups regarding age, sex, blood cell counts, or laboratory markers for inflammation. Pyuria was found in 45.4% of patients with complete KD and in 30.8% of those with incomplete KD (P = 0.17). Of 14 patients who underwent ophthalmological evaluation, two had uveitis; both of them had complete KD.ConclusionIncomplete KD shares with complete KD a risk of coronary artery disease. The diagnosis of incomplete KD is challenging but can be supported by the presence of features other than the principal criteria, such as acute anterior uveitis or unexplained pyuria.     

Operative management of small bowel Crohn's disease

Despite advances in medical treatment, most patients who have Crohn's disease of the small intestine need surgery at some point during the course of their disease. Surgery is currently indicated for intractable disease and complications of the disease (strictures, abscesses, fistulas, hemorrhage). There is increasing interest in nonsurgical and minimal access strategies of dealing with complicated disease, however. These new approaches may enable postponement of surgery to a more favorable time, or conversion of a two-stage procedure involving a stoma to a one-stage resection with anastomosis. A continuing challenge is prevention of disease recurrence postoperatively.