CHIBA, YUKIO

ISHIHARA, HIROSHI

MARUHASHI, KAZUHIRO

MORIMOTO, HIDEKI

MURAOKA, RYUSUKE

TAKADA, YASUTSUGU

TANIGAWA, NOBUHIKO

URATA, YOJI

Kyoto University Research Information Repository

TitleNeonatal Colon RuptureAuthor(s)MORIMOTO, HIDEKI; TAKADA, YASUTSUGU;MARUHASHI, KAZUHIRO; ISHIHARA, HIROSHI; CHIBA,YUKIO; TANIGAWA, NOBUHIKO; MURAOKA,RYUSUKE; URATA, YOJICitation日本外科宝函 (1985), 54(4): 289-293Issue Date1985-07-01URL http://hdl.handle.net/2433/208705RightType Departmental Bulletin PaperTextversionpublisherKyoto University.-¥rch Jpn Chir 54(4), 289～293, 1985 Neonatal Colon Rupture HIDEKI '.¥loRIMOTO、＊ YASUTSUGU TAKADAブKAZUHJRO:'-lARUHASHI,* HIROSHI ISHIHARA,* YuKro CHIBA*, NoBUHIKO TA'.':ICA¥¥"A矢R YUSUKE ¥[ U RAO KA犬andYOJI URATAキ＊The 2nd Department of ~urgery不 and The Department of Central Lal>oratory * Fukui九ledicalS《hoolReceived for Pul>lication, Apr. 8, 1985. ¥:eon a ta! colon perforation or rupture is a r辻reclinical entity and its prognosis is stil poor. The authors salvaged a 2-day-old male neonate who had a sigmoid colon rupture and an im-perforate anus with emergent operation, sufficient dose of antibioticメ andintravenous fluid infusion. The defect of the muscular layer was proved in the ruptured wall of the sigmoid colon. The defect and other mechanical factors mainly concerned to the rupture in this patient. Case Report A 2-day-old 3,400 gm.male neonate was admitted with a 2-day history of vomiting and abdominal distension. He was born to a 29う＇earold gravida 1, para 1 mother by spontaneous delivery with a birth weight of 3、600gm. after 41-week gestation. Hi,; mother presented mild proteinuria and peripheral edema, but didn’t have no other complication on her gravidal period. He cried品pontaneouslyat birth、andrequired no resuscitation. His Apgar score was 10 at one minute and 10 at five. On the first day of life, he vomited when he took 10 ml of 5% glucose solution, and a recurrent episode of vomiting appeared when he took 10 ml of mother milk. On the second day, abdominal distension appeared‘and so he consulted our hospital. On admission, gross abdominal distension and decreased bowel sound were noted. His heart rate was 202/min. and his respiratory rate 70/min. His crying w川 weakbut movement of his extremities was good. He had an imperforate auns with 孔 νerynarrow perineal fistula, through which a litle meconium has passed since birth. He had received litle oral feeding. Laboratory data presented mild hyponatremia and hypocalcemia, but no abnormal hemato-logic finding was found. Roentgenographic investigation revealed a large amount of free <1ir in the intraperitoneal spare. At laparotomy, massive greenish fluid was found in the abdominal c‘日 itv. and extensive faecal peritonitis existed. The longitudinal rupture 3.5 cm in length was detected in the distal one-third sigmoid colon along a taenia coli. Other adjacent segmenb of 1.5 cm proximal a,; well as distal to the rupture were in defect of the muscular layer. Aいo.the rectum and the sigmoid Key words: Neonatal colon rupture (perforation), Congenital muscular layer defect, ;¥Iechanical factor. 索引語：新生児結腸破裂（穿孔），先天性筋層欠損，機械的要因;ddr批 The2nd Department of Surgery and The Department of Central Lauorato恥 Fukui:¥I吋icalSchool, Japan. 290 日外宝：x~s4巻司H号（昭和60年 7 月）Table I. Emergent laboratory data on admission GOT 74 IU/l RBC 501×104/ml BUN 30 mg/di Hb 17.1 g/dl creat1nin 1.3 mg/di Ht 49.1 % TP 5.4巨／di MCV 98.Qμml T-Bil. 6.7 mg/di MCH 34.1 pg Na 131 mEq/I MCHC 34.8g/dl K 3.7 mEq/l WBC 8400/ml Cl 101mEq/l PLT 12.8×104/ml Ca 3.0 mEq/l colon anal to the rupture were dilated. '¥ o other anomaly was detected in the品bdomen.A. double barreled sigmoidostomy w川 performed,and the perforated lesion was primarily closed IiγAlbert Lembert suture after debridement. Fig. l. The longitudinal ruptun白 3.5cm in length w山 detectedin the distal one-third 内igrnoidcolon (A). >lEO'.'¥ATAL C<JLO'.'¥ Rl'PTl'RE 291 After the operation, enough amount of antibiotics was administrated. The postoperative course was unventful cxcぞptmetabolic alkalosis. which was corrected by a careful intr川ぞnousfluid infusion therapy. A perineal fistula was treated with bougienage司 andcut-back method was secondarily performed for an imperforate auns on the 45th day after birth. He W川 dis-charged at 3 months of age, in a good condition, weighing 5,800 gm. Pathology The mucosa of the bowel was well preserved, and the vili were short and covered hv cylindri-cal epithelia. The submucosa was edematous and congested with cellular infiltration. The external and internal coats of the muscular layer at the site of the ruptun・ showed an abrupt interruption, and replaced by a fibrous tissue strand. At this site司 thebowel wall＼＼＇山 composedof the mucosa, the submucosa and the serosa. The rnyenteric nerve plexu、wa'preserved. Discussion Neonatal colon perforation or rupture is a rare but well-known clinical entity. :¥ eonatal intestinal perforation is classified by its perforated site. The colon perforation I、themost frequent next to the gestric perforation 15>. Fi邑.2. The muscular layer showed an abrupt interruption (A), and replaced liy a品lirou'tisue strand ( £ £ ).The mucosa was well preser刊 d.and the sulimucosa 川、edematousand congest-ed with celular infiltration. Also, the myenteric nerve plexus was presen・cd. (original magm五cation：×100)292 日外宝第54巻第4号（昭和60年7月）Etiology of this entity is unknown but several hyposyntheses have been proposed. They include the followings; 1° congenital defect of the muscular layer5•8ヘ 2° elevated intraluminal pressure1•6•10>, 3。localcirculatory disturbance (ischemia, hypoxia9•12•14>), 4° infection including necrotizing colitis4•6 ＞司 5° trauma and instrumentation2•16> and so on. Cause of colon perforation or rupture is not always one, and sometimes several factors concern to it to>. Colon perforation is observed more frequent片ina small-for-date neonate91 It occurs in the neonate who has a complicated disease such as imperforate anus and Hirschsprung’s disease, too2•6>. In the patient‘the existence of an imperforate anus with a very narrow perinea! fistula and the dilated colon and rectum suspected the elevation of the intraluminal pressure. Moreover, a pathological examination revealed the defect of the muscular laryer. This defect was a weak-point to an abnormal pressure. These facts indicate the concern of mechanical factors. There was no history of perinatal asphylaxia and the colon mucosa, which is the weakest to ischemia, was intact. These facts may exclude the concrrn of a local circulatory disturbance (ischemic factors) at least in this patient. The term of colon perforation and rupture has been used obscuely. Authors reported this case as "colon rupture" not "colon perforation円 becausemechanical factors contributed to the formation of this lesion. Generally, the lesion in colon rupture (mainly due to mechanical factors) is large and that in perforation (mainly due to ischemic factors) is small (sometimes pinhole sized) and often multiple . .:¥ eonatal colon perforation or rupture was poor prognosis4,t5> and al cases were fatal in the era when SrMPSON13> reported firstly in 1838、butsome cases became rescure since surgery was indicated and antibiotics was used 3・ 7• 1 > In the treatment of neonatal colon perforation or rup-ture, early diagnosis, prompt operation and administration of su伍cientdos巴ofantibiotics are required essentially. Surgical method includ引 thefollowings2>: 1° primary resection with anastomosis, 2° resection with a proximal colostomァ， and3° primary suture of the defect. Re-section is necessary in the case in which ischemic factors are recognized. References 1) Burt CAV: Pneumatic rupture of the intestinal cana.l Arch討urg22: 875-902, 1931. 2) Cacioppo PL and Gau FC: Idiopathic perforation of the colon in a newborn. Am Jおurg132: 392 393, 1976. 3) Doyle CR: Diagnosis and treatment of meconium peritonitis. Southern Med J 44: 358-360, 1951. 4) George F:VI and Friedberg :¥IJ "-' eonatal perforation of the colon. Am J Obstet Gynecol: 122: 788-789, 1975. 5) Herbut PA: Congenital defect in the musculature of the stomach with rupture in a newborn infact. Arch Path 36: 91 94, 1943. 6) Ku Lista TP, Lynn HB, et al: Spontaneous perforation of the colon in the newborn. ¥Jayo Clin Proc: 45: 103-113, 1970. 7) Lee C¥I Jr and :¥I礼cl¥lilanBG: Rupture of the bowel in the newborn infant. Surgery: 28: 48-66, 1950. 8) Litwin A, Avidor I, et al: Neonatal intestinal perforation caused by congenital defects of the intestinal musculature. A J C P, 81 77←80、1984.9) Llyod JR: The etiology of gastrointestinal performations in thejnewborn. J Pediat Surg 4: 77 84, 1969. 10) Nixon CW. Condon VR, et al: Intestinal perforation as札 complicationof the neonatal small left colon syndrome. Am J Roentgenol Radium Ther "foe! !¥led: 125: 75 80, 1975. :¥'EO¥TATAL C<lLO¥' Rl'l''lTRl・. 2¥:1:1 1) ~almin 、ky R: Perforation of the colon in a neonate who recovered JA¥IA 175: 619-620, 1961. 12) Scholander PF. Hammel HT, et al: ( 'ir《uL1ton礼djustmentin pearl di,・1・"・ J Appl Physiol：・ 17184 190, 1962. 13) Simpson J ¥': Notices of case、ofperitonitis in the foetus in ntero. Edinburgh ¥I引lSurg J: 2: 390‘1838 (quoted from literature 4) 14) T~ul凶kian RJ, Posch JN, ct al: The pa伽日lnl'sis of is巾 mic白川lrol'nln<Holitis of the neonate. J Pediat Surg :7: 194-205, 1972目151 Tucker A日.Soine L, et al: Gastorointestinal perforations in infancy. :¥m J Roentgenol Radium Ther ¥!ucl ¥led 123: 755-763, 1975目16) Zirkovic S. ¥Iilos正、icv、etal: Prenatal巨unshotperforation oi the colon, J Pediat Sur巨 11 591 592可1976. 和文抄録新生児結腸破裂の一治験例福井医科大学第2外科（主任村岡｜盗介教授）森本秀樹，高田泰次，丸橋和弘，石原 浩千葉幸夫，谷川允彦，村岡隆介問中央検査部浦田洋新生児の結腸破裂（穿孔）は希であり，その予後は今なお芳しくない．著者らは，手術及び綿密な術後管理！とよって救命し得た低位鎖紅を伴うメ状結腸破裂の新生児症例を経験した 本症例においては，病理学的に腸管壁の筋層欠損を,:2め，これが結腸破裂の主因であったと考えられた．

新生児結腸破裂の一治験例

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新生児結腸破裂の一治験例

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