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題 名 | Toxic Megacolon Secondary to Infective Colitis in Children=繼發於兒童感染性腸炎之毒性巨結腸症 |
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作 者 | 蔡紫君; 吳子聰; 魏拙夫; 黃碧桃; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 99:3 2000.03[民89.03] |
頁 次 | 頁199-205 |
分類號 | 416.245 |
關鍵詞 | 兒童; 感染性腸炎; 毒性巨結腸症; Toxic megacolon; Gut failure; Salmonellosis; Infective colitis; |
語 文 | 英文(English) |
英文摘要 | Background and purpose: Toxic megacolon is a fulminating and potentially lethal complication of severe colitis. Toxic megacolon secondary to infective colitis in children is rare. We analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children. Methods: The medical records of all 20 children treated for infective colitis complicated with toxic megacolon during a 12-month (October 1997–October 1998) period were retrospectively reviewed. Results: There were 10 boys and 10 girls, with a mean �v�nstandard deviation, SD) age of 26.2 �b�n12.9 months (range, 6–57 mo). With an initial presentation of nonspecific gastroenteritis syndrome lasting several days, the disease progressed rapidly. In the acute stage, most patients developed toxic signs such as mental change, ranging from irritability to stupor (20, 100%), fever (19, 95%), tachycardia (20, 100%), abdominal distension (20, 100%), and abnormal stool pattern (19, 95%). Initial investigations revealed anemia (11, 55%), leukocytosis (11, 55%), and elevated levels of C-reactive protein ranging from 25.0 mg/L to 483.0 mg/L with a mean �b�nSD of 185.7 �b�n129.1 mg/L (normal range, < 8 mg/L) (20, 100%). Salmonella enteritidis (12 patients, 60%) and Clostridium difficile (1, 5%) were isolated from stool samples in some cases. Plain abdominal x-rays revealed severe colonic dilatation. Prolonged hospitalization (mean, 33.6 d) and intensive therapy including a combination of broad-spectrum antibiotics, physical decompression, and total parenteral nutrition were necessary. Three patients (15%) underwent surgical management; the pathologic findings in these patients demonstrated severe transmural inflammation. We believe that bacterial and/or endotoxin translocation played an important role in gut failure. Three patients (15%) in the study died. Conclusion: Toxic megacolon in infective colitis is a fulminating illness that has a high mortality rate. The disease course can be divided into three stages: the acute toxic stage, the gut failure stage, and the convalescence or deterioration stage. Early diagnosis and aggressive management are important. |
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