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便秘，结肠狭窄，早产

亲爱的编辑,

肠狭窄是早产儿坏死性小肠结肠炎(NEC)的晚期并发症之一。肠梗阻可表现为胆汁性呕吐、腹胀或便秘等症状。在这里，我想强调一例因结肠狭窄导致便秘并伴有早产的病例。一名3个月大女性，因便秘腹胀6天入院。她有30孕周早产的故事，体重1930克。据她的母亲说，她在新生儿重症监护室随访了43天，由于大便带血，口服喂养已停止约10天。体检时体重3000克，腹部肿胀但柔软。直立腹部x线片显示气胀和无气骨盆(图1A)。患者有便秘、腹胀、躁动等远端肠梗阻症状。估计患儿出生后在NICU有NEC的临床图。 Contrast enema revealed 2 stricture sites in colon; middle of transvers colon (10 cm long) and between descending and sigmoid colon (15 cm long) (Figure 1B). She was operated, and two stricture regions of colon were resected, and 2 colo-colonic anastomoses were done (Figure 1C). Post- operative course was uneventful. She was discharged 7 days later. She was well with 11250 gr weigh in the first year of surgery. Necrotizing enterocolitis (NEC) is a severe gastrointestinal intestinal inflammatory process often effecting premature babies. It progresses with significant mortality rates in acute stage. Clinical presentations of NEC are feeding intolerance, abdominal distention, bloody stools and severe hemodynamic instability. Treatment consists of nasogastric suction, intravenous fluids, parenteral antibiotics and, in some cases surgery if intestinal obstruction or perforations are occurred [1,2]. But beyond acute stage, NEC has unignorable morbid complications such as short bowel syndrome and intestinal stricture which results of recovery of affected sites of ischemic intestinal segments [1,3]. It should be taken into consideration that in infants, who have obstructive symptoms with a history of premature birth, had developed post-NEC stricture [4]. It is reported that colon is the commonest site for stricture after NEC [5].When patients have intestinal obstruction with premature birth story, contrast enema is recommended to evaluate of colonic patency and to rule out diagnosis of stricture before operations [1,4,5]. It is known that if the stricture involved colonic segments patients can be asymptomatic for a while and tolerate feeding well until obstructive symptoms is occurred day by day. If prolonged constipation is not investigated patients can gradually face to high morbid complication such as intestinal obstruction, septicemia or perforation because of post-NEC strictures [1,5]. Colonic stricture following NEC should be index of suspicious for all clinicians who see the patients with premature birth story and with intestinal obstruction. Because the large intestine is storage organ the obstructive symptoms due to colonic stricture may not occur as early as obstructive symptoms of small intestinal stricture. I want to emphasize that colonic strictures should be stated in mind when premature birth infants present with constipation. For these reasons I wanted to explain how necessity of regular follow-up and information of family for such complications of NEC mentioned here, is important.

图1。一个。直立腹部x线片显示肠梗阻B。对比灌肠显示横结肠和降结肠狭窄C。手术中结肠狭窄

参考文献

1. 刘永华，刘永华等。坏死性小肠结肠炎。见Arnold G. Coran(编)，儿科外科(第七版)，纽约，2012。页187 - 1207。
2. 张志刚，张志刚，张志刚。坏死性小肠结肠炎并发脓毒症或穿孔的临床观察风险。儿科外科医生23日:562 - 566。(Crossref)
3. Heida FH, Loos MH, Stolwijk L, Te Kiefte BJ, van den Ende SJ，等(2016)婴儿坏死性小肠结肠炎狭窄的危险因素。儿科外科医生51: 1126 - 1130。(Crossref)
4. Phad N, Trivedi A, Todd D, Lakkundi A(2014)坏死性小肠结肠炎后肠狭窄的临床特征和危险因素。新生儿外科3: 44。(Crossref)
5. Burnand KM, Zaparackaite I, Lahiri RP, Parsons G, Farrugia MK，等(2016)对比研究在坏死性小肠结肠炎后肠狭窄评估中的价值。儿科外科32: 465 - 470。(Crossref)