川崎病并发急腹症的再认识

川崎病(KD)是一种以全身血管性病变为主的急性发热性出疹性疾病,多发于婴幼儿,主要累及全身中小动脉,可并发冠状动脉病变、心肌炎、间质性肺炎、无菌性脑膜炎等。近年来KD并发急腹症,如胆囊炎、胰腺炎、肠梗阻等也受到重视,早期识别KD并发急腹症的表现,及时给予相应治疗,有助于改善KD致冠状动脉病变及并发急腹症的预后。     

小儿急腹症中的妇科问题

目的：分析小儿妇科疾病引起的急腹症的特征及临床误诊原因，并提出避免误诊的方法。方法：回顾我院外科1990－2001年以急腹症为主要表现的女性小儿生殖系统病例20例，年龄2－14岁，平均10．2岁。其中：卵巢囊肿4例，卵巢畸胎瘤7例，卵巢恶性卵黄囊肿1例，黄体破裂3例，处女膜闭锁2例，盆腔炎2例，原发性痛经1例，结果：术前误诊4例，黄体破裂误诊为阑尾炎2例，卵巢囊肿误诊为阑尾炎1例，处女膜闭锁误诊为盆腔包块1例，手术治疗16例，抗炎止血等保守治疗3例，解痉止痛1例，全部病例均痊愈出院。结论：小儿妇科急腹症分为破裂性疾病，肿瘤和炎症，幼童期1－9岁以肿瘤性疾病为主，青春期9岁以后即要考虑特有疾病如处女膜闭锁以及黄体破裂等，术前要了解科情况，诊断急性阑尾炎有疑问但又确有手术指征时，可以采取腹直肌纵切口。除非证实肿瘤为恶性，否则应尽量保留卵巢。     

Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen

Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.     

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目的探讨小儿异位胃黏膜症合并急腹症的临床特点。方法回顾分析了2000-12—2005-12中国医科大学第二临床学院收治的55例经病理证实存在异位胃黏膜的急腹症患儿,对其临床资料进行分类汇总和分析。结果男44例,女11例;年龄3个月至13岁,平均4·5岁。临床诊断下消化道出血31例,急性肠套叠13例,急性肠梗阻5例,急性腹膜炎6例;手术切除肠管标本经病理检查证实均有异位胃黏膜。其中Meckel憩室40例,肠重复畸形11例,肠壁正常4例。结论异位胃黏膜可能是小儿急腹症的病因之一;急腹症患儿ECT检查阴性也应开腹探查,以免遗漏异位胃黏膜。     

Post varicella hepatic actinomycosis in a 5-year-old girl mimicking acute abdomen

Actinomycosis is an indolent, slowly progressive infection caused by gram-positive, anaerobic or microaerophilic bacteria. Hepatic involvement is rare and generally secondary to abdominal or thoracic actinomycosis. Hepatic actinomycosis in children may mimic a wide variety of diseases and thus make the diagnosis much more challenging. Here, we report a 5-year-old girl with apparently primary hepatic actinomycosis mimicking acute abdomen 2 weeks after varicella. The diagnosis was made by ultrasonic guided fine needle aspiration biopsy of a hypoechoic lesion of 3.5 cm diameter in the liver showing sulfur granules surrounded by neutrophils. Hepatic actinomycosis should be taken into account when evaluating acute abdomen symptoms in children.     

An unusual cause of acute abdomen: torsion of colonic duplication over a duplicated appendix

A 2-year old boy with torsion of colonic duplication, which had a proximal communication with the cecum via an incomplete duplicated appendix, is presented. The clinical picture and complications of this rare association are discussed.     

Imaging of acute appendicitis: US as the primary imaging modality

Background: The investigation of the acute abdomen in infants and children has evolved during the last two decades, placing imagers at the forefront of the evaluation and diagnosis of acute right lower quadrant abdominal problems. US and CT have recently been shown to be equally accurate in the diagnosis of acute appendicitis, but not everyone agrees. Objective: To demonstrate the efficacy of triaging patients with acute abdominal problems that suggest appendicitis with US as the primary imaging modality. Materials and methods: We retrospectively reviewed the prospective imaging diagnoses in 622 children who presented to our emergency room (ER) and clinics with acute abdominal symptoms suggestive of appendicitis. We documented whether US or CT was performed and noted the diagnoses made. All of the patients had plain films. In addition, all patients undergoing surgical appendectomy during this time were also documented so as not to miss any cases of appendicitis. None was missed. Results: There were 622 consecutive patients in our study. Three patients, diagnosed as normal, were eventually excluded because of lack of follow-up. In all, 152 patients were evaluated clinically and with plain films only. They were not subject to surgical exploration or further imaging. None returned with appendicitis. Eighty-one patients were directly subject to laparotomy after clinical and plain film evaluation. Of these patients, 20% had a normal appendix. Of the remaining 389 patients, 386 had US and three had CT alone. Four patients had both CT and US because of an inconclusive US examination. Three patients had CT alone because of their size. In total, 137 patients were diagnosed with appendicitis with US and/or CT. Four of these patients (3%) had normal appendices. Forty-two patients (less three lost to follow-up) were diagnosed as normal, and none returned with findings of appendicitis. Nine others had conditions other than acute appendicitis. Three had surgically proven, nonrelated conditions, and of the other six, one had pancreatitis and five nonsurgical adnexal problems. In all, 201 patients were diagnosed (with US) with mesenteric adenitis–enteritis, and none returned with findings of appendicitis. Conclusion: We attained a high degree of diagnostic accuracy in patients presenting with findings suggestive of appendicitis using US as the primary imaging modality. Our false-positive appendectomy rate was 3%. Therefore, triage of the acute abdomen with US supported by CT when required has considerable merit, especially when considering that US is noninvasive and does not use ionizing radiation.     

Rapidly enlarging solitary nonparasitic cyst of the liver in a child presenting as acute abdomen

Symptomatic solitary nonparasitic cysts of the liver (SNCL) are rarely encountered in children, especially rapidly enlarging cysts presenting as acute abdomen. Therefore, it is difficult to establish the pre-operative diagnosis and to determine the treatment protocol of SNCL. While imaging techniques such as ultrasonography and computed tomography are modalities for diagnosis of SNCL, making a pre-operative diagnosis in the case of very large cysts remains difficult. We present a child with SNCL who initially presented with a rapidly enlarging cyst presenting as acute abdomen, and also provide a review of the literature. Moreover, we evaluate the surgical procedures and conclude that total excision of the cysts when possible is a suitable treatment procedure in children. This study was not supported by any grant.     

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??Sudden and violent abdominal pain with comparatively fixed location should be clinical features in children with acute abdominal diseases. The constant development of system and organs in childhood makes it difficult for pediatricians to make correct diagnosis of pediatric acute abdomen. Complete inspection and particularly abdominal palpation and digital examination should be emphasized. Correct understanding of abdominal pain in children with acute abdominal diseases is of critical importance.     

急诊疑似阑尾炎VCT平扫与术后病理诊断对照准确性研究及影像学特征

目的以手术和病理诊断为金标准,探讨VCT平扫对急诊疑似阑尾炎的诊断价值。方法 2008年6月至2009年5月对急诊疑诊阑尾炎患儿行VCT平扫检查,与随后进行的外科手术病理学检查结果对照。统计分析VCT平扫诊断的准确性、敏感度、特异度、阴性似然比及阳性似然比。并分析急性阑尾炎和其他急腹症的VCT影像学特征。结果 284例患儿中手术和病理学检查诊断急性阑尾炎270例,VCT平扫诊断急诊阑尾炎243例。VCT平扫对急诊阑尾炎的诊断准确性为90%(95%CI:87%～92%)、敏感度为0.91(95%CI:0.87～0.94)、特异度为0.89(95%CI:0.85～0.93)。进一步根据阑尾炎病理学检查结果行亚组分析,结果显示,急诊单纯性阑尾炎的VCT诊断准确性为62.3%,急诊化脓性、坏疽性和穿孔性阑尾炎的诊断准确性均95%。漏诊和误诊的27例急诊阑尾炎中,包括23例单纯性阑尾炎,4例化脓性阑尾炎(3例被误诊为盆腔右侧附件病变,1例被误诊为右侧输尿管下端结石)。284例中14例为其他原因急腹症,VCT平扫准确诊断11例(78.7%),漏诊3例,包括肠系膜裂孔疝、梅克尔憩室扭转及索带压迫各1例。急性阑尾炎患儿典型的VCT特征为阑尾周围脂肪间隙模糊,阑尾增粗(直径为5～19mm),阑尾壁增厚。结论 VCT平扫对于急诊疑似阑尾炎的诊断具有显著意义,但对于单纯性阑尾炎的诊断准确性较低,必要时应行增强VCT检查以提高诊断准确性。     

小儿过敏性紫癜并发急腹症的影像学表现及临床意义

目的：小儿过敏性紫癜并发急腹症前后,其影像学表现无论是腹部X线、CT或B超,以前均有报道,但综合在一起讨论其特点的报道较少。该文回顾性分析36例小儿过敏性紫癜并发急腹症患儿的临床资料,探讨其影像学特点及临床意义。方法：回顾性分析36例小儿过敏性紫癜并发急腹症患儿的临床资料。结果：出现并发症前,B超、CT检查均显示多发节段性受累肠壁水肿增厚,肠管狭窄,受累区域肠系膜模糊不清;出现并发症后,B超在检查并发肠套叠时具有价廉、准确的特点;在检查并发肠坏死穿孔时,腹部X线正立、侧卧位像及CT有较高的敏感性;在检查肠梗阻及监测其变化时,腹部X线正立、侧卧位像有重要的意义。结论：在出现并发症前,小儿过敏性紫癜的影像学表现重要性在于可以与需要手术的其他急腹症相鉴别,典型的影像学表现可以提示诊断;在出现并发症后,可以及时发现并发症和指导临床治疗。     

Acute aortic dissection mimicking acute abdomen in a 14‐year‐old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.     

儿童急性巨核细胞白血病临床生物学特征分析

目的探讨儿童急性巨核细胞白血病的临床及生物学特征。方法对11例AMKL患儿临床资料进行分析总结。结果实验室检查可见骨髓原幼巨核细胞比例增高>30%;骨髓纤维组织广泛增生;外周血或骨髓中检测到小巨核细胞;CD41、CD61表达明显增高;非特异性酯酶(NSE)、幼稚细胞糖元染色(PAS)、酸性磷酸酶(ACP)阳性率增高;电镜幼稚细胞血小板过氧化物酶(PPO)阳性;复杂染色体核型异常多见。结论AMKL占儿童AML7%~10%,多发生于婴幼儿,临床表现及生物学特征复杂,误诊率高,预后不良,应引起临床工作者的重视。     

Selective surgical indication in the management of neutropenic children presenting with acute abdomen

As the treatment of pediatric malignancies improves and survival increases, the diagnosis of acute abdomen in these patients also becomes more common. Nevertheless, the management of this a condition is still controversial. The authors report their experience in treating 12 neutropenic children with acute abdomen. The charts of 12 neutropenic patients with a diagnosis of acute abdomen treated at Boldrini Children's Cancer Center in Campinas, Brazil, between 1991 and 1996, were reviewed. Therapeutic strategy included an initial period of bowel rest, general supportive measures, and broadspectrum antibiotics while waiting for the neutrophil count to rise. Three patients recovered completely without surgery, 8 under went late surgery without complications, and 1 died due to uncontrolled sepsis before surgery. The treatment of acute abdomen in neutropenic children remains controversial. As shown in the present series, an initial nonoperative approach with selective surgical indication appears to be safe and to yield good results. Supportive treatment, until the neutrophil count rises, followed by surgery, if necessary, appears to be a sound therapeutic approach for neutropenic children with acute abdomen.     

高迁移率族蛋白B1对儿童急性阑尾炎的诊断价值

目的 探讨高迁移率族蛋白 B1（HMGB1）对儿童急性阑尾炎的诊断价值。方法 2013 年 1~7月门诊及住院疑似急性阑尾炎的急腹症患儿及同期来院体检的 25 名健康儿童纳入该研究。入院后采用 ELISA检测血清 HMGB1 水平。根据手术所见及病理学检查结果等将患儿分为急性阑尾炎组（n=28）和非急性阑尾炎急腹症组（n=35）。结果 急性阑尾炎组和非急性阑尾炎急腹症组外周血 WBC、血清 HMGB1 均显著高于健康儿童组（PP结论 HMGB1 对儿童急性阑尾炎具有一定的诊断价值。     

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study北大核心CSCD

目的 探讨生长抑素对急腹症患儿术后胃肠功能及应激水平的影响。 方法 选取2019年8月至2021年6月徐州市儿童医院收治的行手术治疗的102例急腹症患儿为研究对象。将患儿随机分为观察组和对照组,每组各51例。对照组患儿术后给予止血、抗感染等常规治疗,观察组在常规治疗的基础上加用生长抑素。术前、术后第1天及术后第5天采集两组患儿外周血,比较两组患儿血清血管内皮素-1（endothelin-1,ET-1）、促肾上腺皮质激素（adrenocorticotropic hormone,ACTH）、皮质醇（cortisol,Cor）及胃泌素、胃动素水平,以及两组患儿术后恢复情况及并发症发生率。 结果 术前两组患儿血清ET-1、ACTH、Cor、胃动素及胃泌素水平差异无统计学意义（P>0.05）。术后第1天、第5天,观察组患儿血清ET-1、ACTH、Cor水平均显著低于对照组（P<0.05）;术后第5天,观察组患儿胃动素与胃泌素水平均高于对照组（P<0.05）。术后观察组患儿首次肛门排气时间、肠鸣音恢复时间、首次排便时间、住院时间均较对照组缩短（P<0.05）。观察组并发症发生率（6%）显著低于对照组（24%,P<0.05）。 结论 生长抑素可显著降低急腹症患儿术后应激反应,改善胃肠功能,降低并发症发生率,有益于疾病预后。     

Helicobacter pylori and recurrent pain abdomen

Objective : Pain abdomen is a common problem in childhood. Many factors i.e., organic changes in the gut, psychological and environment contribute to recurrent pain abdomen (RAP) in children. Helicobacter pylori infects children very early in childhood and stays indefinitely in the gut without its eradication. It may be responsible for pain abdomen and peptic ulcers in children. This study was done to assess the HP status in children with RAP diagnosed and evaluate the effects of eradication of HP infection in them.Methods: 76 children were included in the study.Result: Out of 76 children studied 14.8% had evidence of a secondary cause for pain abdomen and responded to appropriate therapy. 65.45% of children who had undergone UGIE, had evidence of HP infection in the upper gastrointestinal tract. Most of these children responded to HP eradication therapy by becoming free of abdominal pain after the eradication therapy with OCA or OMA regimen. We could not do repeated endoscopies in all of them to prove the eradication due to parents’ refusal and this is the main drawback of this study.Conclusion: However, in view of clinical response to HP eradication therapy in almost all the cases, we strongly advocate this therapy for those children with RAP, in whom HP infection of the upper gastrointestinal tract can be established beyond doubt.