小儿常见消化系统外科疾病.ppt

Soft-tissue shadow (a crescent of gas at its apex) Surgery: failure of reduction, over 48-72 hours, peritonitis, perforation, small bowel intussusception Intussusception of children? Diagnostic process typical / atypical symptoms sausage-shaped mass Ultrosonography enema Question When an infant has vomiting, what should we do? How does the baby be diagnosed? Reference 1.Keith W. Ashcraft: Pediatric Surgery (3rd edition). Philadelphia, WB Saunders, 2000 2.Journal of Pediatric Surgery Common Diseases in Pediatric Surgery Case 男婴，45天， 呕吐近1个月 呕吐特征： 颜色与性状 时间与规律 性质 Vomiting: free of bile juice 2~4w after birth 20-30’ after milk projectile (bloodstained) 体检： T 37.6 度，R 35次/分，HR160次/分 WT 3.2Kg， 皮肤无黄染、有皱纹、弹性差。 前囟凹陷，张力低。 腹部平坦，腹壁不红肿，可见胃型和蠕动波， 肝脏软，右肋缘下1cm ，肠鸣音6-8次/分。 实验室检查: WBC 10.2×10︿9/L, RBC 4.8 ×10 ︿9/L, HGB 180g/L, PLT 225 ×10 ︿9/L, Na+ 122 mmol/L, K+ 2.9mmol/L, Cl - 85 mmol/L, HCO3- 28 mmol/L, Q: 最可能的病变部位？ 再体检： A small, olive-shaped，firm, mobile lump（tumor) could be touched under the liver 婴儿肥厚性幽门狭窄 Infantile Hypertrophic Pylorus Stenosis, IHPS Normal pylorus Pyloric Stenosis Ultrasound: pyloric muscle 7mm (normal ＜ 4 mm) an elongated and narrowed pyloric canal a dilated stomach with strong peristalsis pyloric canal: the beak sign the string sign diameter ＜ 2mm length 11mm Differential diagnosis : Gastric Volvulus Gastroesophageal Reflux, GER Congenital Diaphragmatic Hernia, CDH Esophageal Hiatal Hernia,EHH Intervention? Emergency ? Management Management Decompression and correction of alkalosis - normal saline infusion with potassium procedure of pyloromyotomy Co