小児緊急外科疾患とそのX線像

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書誌事項

タイトル別名
  • PEDIATRIC SURGICAL EMERGENCY AND ITS RADIOLOGICAL FEATURES
  • ショウニ キンキュウ ゲカ シッカン ト ソノ Xセンゾウ
  • (18) PERFORATION OF THE CECUM IN THE NEWBORN INFANT
  • (18) 新生児盲腸穿孔

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A case of perforation of the cecum in a two-day-old boy was presented. He started to vomit green bile from the night of the birth day. As his abdomen became distended on the second day of life, he was transfered to our institutions. A scout film of the abdomen on admission to the Tomioka-Kosei Hospital showed free intraperitoneal air with gas distension of stomach and upper intestine. There were a few scattered gas shadows in the right lower quadrant of the abdomen but no further gas shadow was visible, and the dilatation of a loop of jejunum in the left upper quadrant was noted. Under the preoperative diagnosis of a diastatic perforation of the small bowel due to congenital stenosis or atresia, the emergency celiotomy was carried out. On laparotomy, a large amount of purulent ascites with meconium gushed out. A segmental dilatation of the upper jejunum was found, but the small bowel tapered gradually toward the terminal ileum and neither atresia nor stenosis was found. By means of the systematic examination of the gastrointestinal tract, a perforation of the anterior wall of the cecum with contracted small caliber colon suggestive of an entire colon aganglionsis was found. The perforated cecum was exteriorized and the abdominal cavity was irrigated and drained. The appendix was removed for histological verification of the ganglion cells and it was reported as aganglionic. Postoperative course was uneventful, however, the postoperative barium enema revealed the small caliber colon, but the delayed film demonstrated almost normal evacuation of the contrast material contradicting to the aganglionosis. Thus, the etiology of this perforation of the cecum is unknown at present.

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