臨牀消化器内科 Vol.20 No.6(6-3)


特集名 小児の腹痛とその処置 -- 最新の捉え方
題名 腹痛をきたす小児の重要疾患 -- その診断と治療 (2) 小児における腸重積症,嵌頓鼠径ヘルニア,その他の腹部救急疾患について
発刊年月 2005年 06月
著者 千葉 庸夫 仙台医療センター小児外科
【 要旨 】 小児期の腹痛をきたす疾患には種々なものがあるが,外科的治療が必要となるものは早急に診断する必要がある.本稿では,虫垂炎を除いた疾患のうち日常の診療において経験する可能性のある腸重積症,嵌頓鼠径ヘルニア,メッケル憩室関連疾患,腸回転異常症について,その概要と診断方法について述べる.小児では発生学的な知識も必要であり,その病態も成人とは異なっていることがあり注意を要する.
Theme Abdominal Pain in Children : Current Clinical Management
Title Intussusception, Incarcerated Inguinal Hernia, and Other Abdominal Emergency Disease in Children
Author Tsuneo Chiba Department of Pediatric Surgery, Sendai Medical Center
[ Summary ] There are many emergency abdominal conditions in children. Among these conditions, intussusception, incarcerated inguinal hernia, Meckel's diverticulum, and malrotation of the small intestine are described in.
The sudden onset of symptoms, such as vomiting, abdominal pain and bloody stool are the characteristic findings of intussusception. Nonsurgical treatment is usually recommended for the early stages of this disease. Incarceration of the inguinal hernias is often seen within the first year of life. When incarceration occurs, local swelling is quite painful. Vomitting is common and all the major symptoms of obstruction may appear when the intestine is caught for several hours. Symptoms of Meckel's diverticulum vary with different complications. The clinical course seems similar to that of acute appendicitis. It can be identified by the use of an abdominal scan, using a 99 m-technetium. Malrotation of the intestine often causes a volvulus of the midgut. It sometimes leads to infarction of the entire midgut. A barium enema will show the cecum in the right upper quadrant, and verifies an incompletely rotated position. An emergency operation is usually recommended for this condition.
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