Differential diagnosis and treatment of intestinal perforation caused by neonatal necrotizing enterocolitis and Hirschsprung′s disease
10.3760/cma.j.issn.2095-428X.2019.21.011
- VernacularTitle: 新生儿坏死性小肠结肠炎和先天性巨结肠肠穿孔的鉴别诊断和治疗
- Author:
Yu LIN
1
;
Xiaojuan WU
2
;
Wenhua HUANG
1
;
Ting HUANG
1
;
Yunjin WANG
1
;
Jianqin ZHANG
1
;
Dandan LI
2
Author Information
1. Department of Pediatric Surgery, Fujian Provincial Maternity and Children′s Hospital, Fuzhou 350001, China
2. Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
- Publication Type:Journal Article
- Keywords:
Infant, newborn;
Intestinal perforation;
Necrotizing enterocolitis;
Hirschsprung′s disease
- From:
Chinese Journal of Applied Clinical Pediatrics
2019;34(21):1645-1648
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To retrospectively analyze the differential diagnosis and treatment strategy of neonatal intestinal perforation caused by neonatal necrotizing enterocolitis (NEC) and Hirschsprung′s disease (HD).
Methods:The clinical data of 42 cases with NEC and 22 cases with HD combined with intestinal perforation from Ja-nuary 2012 to January 2017 admitted at Fujian Provincial Maternity and Children′s Hospital were collected, the proportion of premature infants, and the proportion of low birth weight infants, age of onset, preoperative clinical symptoms and surgical treatment was compared between the two groups.
Results:The proportion of premature infants[95.23%(40/42 cases) vs.27.27%(6/22 cases)], the proportion of low birth weight infant[90.48%(38/42 cases) vs.45.45%(10/22 cases)]and the age of onset [(14.48± 10.51) d vs.(3.18±3.43) d]were statistically different between the NEC group and the HD group, and the differences were statistically significant(all P<0.05). There were significant differences in the presence of normal defecation before the operation[71.4% (30/42 cases)vs.27.3%(6/22 cases)], and in the the defecation characteristics at the onset[95.2% (40/42 cases)vs.9.1%(2/22 cases)]between the NEC group and HD group(all P<0.05). Among 42 cases of NEC patients, 8 cases underwent intestinal anastomosis, and 34 cases underwent enterostomy because of the high risk of anastomosis.All of 22 patients with HD underwent double-lumen enterostomy.
Conclusions:The general conditions, preoperative manifestations and intraoperative fin-dings of the children should be comprehensively analyzed for identification.Enterostomy is recommended for NEC intestinal perforation, but if the risk of anastomosis is high, then fistula should be performed.Double-lumen fistula should be recommended for HD intestinal perforation, and enterostomy should be recommended if the two cannot be clearly distinguished.
