新英格兰:因十二指肠蹼引起的新生儿胃积气

一个 4 个月大的女性患儿拒食并伴有非胆汁性呕吐。患儿 1  月时曾因为轻度呕吐而住院治疗,期间患儿可以哺乳。但是 1 周患儿出现呕吐并拒食。体检发现患儿一般症状尚可,腹部膨胀,触之柔软。实验室检查示低氯性代谢性碱中毒;X 线示胃积气(图 A 和 B 箭头所示)。患儿给予鼻胃管留置,静脉补液治疗。上消化道 X 线造影检查示造影剂可通过胃到达小肠;后续 X 线显示积气和「双气泡」,提示十二指肠梗阻(图 C)。术中确认十二指肠梗阻因十二指肠蹼引起,患儿行十二指肠吻合术,术后患儿症状逐渐减轻。



胃积气比较罕见,可能因缺血或者感染导致黏膜破坏,从而气体渗透到胃壁而引起。新生儿胃积气与坏死性小肠结肠炎有关,但是十二指肠梗阻,幽门狭窄或乳源性肠胃结石(lactobezoar:酪蛋白质凝块能导致乳酸胃石,是奶和粘液在胃内形成的凝块,好发于1岁以内的婴儿,尤其是1个月以内的新生儿)导致的严重梗阻也可能会引起胃积气。

Gastric Pneumatosis


A 4-month-old girl presented with poor feeding and nonbilious emesis. At 1 month of age, she had been hospitalized briefly for emesis but was able to feed until 1 week before presentation. She appeared well, and her abdomen was soft but distended. Laboratory investigations revealed a hypochloremic metabolic alkalosis, and radiographs showed gastric pneumatosis (Panels A and B, arrows). A nasogastric tube was placed, and intravenous administration of fluids was started. Radiography of the upper gastrointestinal tract with contrast revealed contrast medium passing into the small intestine; follow-up images showed resolution of pneumatosis and a “double bubble,” which suggested duodenal obstruction (Panel C). Duodenal obstruction caused by a duodenal web was identified intraoperatively, and a duodenoduodenostomy was performed, which resulted in resolution of symptoms. Gastric pneumatosis is rare and probably results from mucosal disruption due to ischemia or infection that allows gas to infiltrate into the wall of the stomach. In newborns, gastric pneumatosis is associated with necrotizing enterocolitis, but increased intragastric pressure from severe obstruction caused by duodenal blockage, pyloric stenosis, or a lactobezoar may also produce gastric pneumatosis.


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