新生児の消化管穿孔

Perforation of the Digestive Tract in the Newborn

　新生児の消化管穿孔はさほど珍らしいものではない．大阪小児保健センター外科で，筆者が赴任後僅か3年間で8例が経験されている．筆者が阪大時代の例を加えるとその数は倍以上になる．

　近年のわが国の経験例数を，小児外科関係の雑誌からちょっと拾ってみても，小児外科症例を多く取り扱う施設では，かなりの数を報告している．昨年の仙台での第7回小児外科学会¹⁾で，東京医大6例，広島県立病院12例，東北大13例，広島大5例，岡山大1例などの報告があり，近刊の雑誌では，名市大19例²⁾，長崎大³⁾5例（剖例18例を合すると23例），など，ゴロゴロしている．

　Perforation of the digestive tract in the newborn, quite different from that in the adult not only in its clinical manifestations but also in its etiology, has been described by classifying its causes into the following three categories.

　1) Perforation with distal obstruction.

　Rise in intraluminal pressure accounts for rupture and perforation of a segment of the digestive tract.

　2) Perforation without distal obstruction. 　a) Perforation where some causes are presumed, such as ulcer, an accident due to catheterization into the stomach, or cerebral injury.

　b) Spontaneous perforation of unknown etiology.

　As clear distinction is difficult between a) and b) both have been discussed together in detail.

　It is true that clinical picture of perforation of the digestive tract presents some characteristic features such as the existence of free air in the upright abdominal x-ray picture so that its early diagnosis, which has important bearing on postoperative prognosis, is not difficult. However, in our experience referred cases in its early stage have been regrettably few. It is probably because there are not many clinicians in our country who have enough practical knowledge to adequately handle emergency cases needing immediate surgical intervention.

　The clinical aspects have been left out in the text, and instead personal cases in the figures have been fully described.