CHẨN ĐOÁN LỒNG RUỘT( LR) Ở TRẺ EM

DANH MỤC CHIA SẼ
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BS.CKII Nguyễn Trọng Nghĩa

I. ĐẠI CƯƠNG

– Lồng ruột là tình trạng bệnh lí được tạo nên do một đoạn ruột chui vào lòng của đoạn ruột kế cận.

– Là một trong những nguyên nhân thường gặp nhất gây tắc ruột cơ học mà cơ chế vừa là bít nút vừa là thắt nghẽn tạo thành một chuỗi biến chứng nguy kịch nếu không kịp thời chẩn đoán và điều trị.

Là một trong những cấp cứu bụng thường gặp nhất ở nhũ nhi.

Tần suất rất khó đánh giá theo vị trí địa lý, theo ba nghiên cứu ở Anh cho tần suất 1,6-4/1000 trẻ sinh sống.

Ưu thế phái tính nam với tỉ lệ 2/1.

Tuổi

0,3% dưới 1 tháng; 80-90% dưới 24 tháng, với đỉnh cao từ 3-9 tháng tuổi.

Lồng ruột xãy ra sau 2 tuổi thường nằm trong nhóm lồng ruột thứ phát.

– Đa số tác giả ghi nhận có sự trùng hợp giữa mùa bệnh viêm ruột, viêm phổi, viêm phế quản với sự gia tăng tỉ lệ mắc bệnh..

– Theo kinh điển lồng ruột thường xảy ra ở trẻ bụ bẫm, hiếm thấy ở trẻ suy dinh dưỡng.

II. SINH BỆNH HỌC

LR cấp tính ở nhủ nhi

Liên quan đến tình trạng lối lọan nhu động ruột mà bệnh căn còn chưa rõ. Không thấy rõ tổn thương thực thể khi mổ. có nhiều giả thuyết giải thích.

Chính sự phì đại chủa tổ chức lympho ở mạc treo ruột tạo nên cản trở nhu động ruột.

Nhiễm siêu vi gây tăng nhu động ruột.

Ưu thế thần kinh X ở trẻ nhũ nhi.

Áp lực ổ bụng tăng.

Manh tràng di động.

Các tổn thương thực thể khu trú. ( trẻ lớn)

– 1,5 – 12% lồng ruột có khởi điểm từ túi thừa Meckel, polyp ruột, nang ruột đôi…

III. TRIỆU CHỨNG

1. Lâm sàng

– Khóc thét từng cơn do đau bụng. Mỗi cơn khóc kéo dài 5-10 phút, trong cơn đau trẻ
tái nhợt, vã mồ hôi. Giữa 2 cơn đau, trẻ mệt lã.

– Bỏ bú

– Nôn ói: chiếm 45% trường hợp, thường xuất hiện sớm sau khóc thét

– Tiêu phân nhầy máu: thường xuất hiện khoảng 12 giờ sau cơn đau đầu tiên.

– Khám bụng: 85% trường hợp có thể phát hiện khối lồng; hố chậu phải rỗng.

– Thăm trực tràng thấy rỗng và có thể có máu theo găng.

– Triệu chứng toàn thân: Ban đầu chưa có dấu hiệu thay đổi, sau đó bé mệt, li bì da khô….

– Khối lồng: sơ thấy khoản 85%

2. Cận lâm sàng

– Siêu âm bụng tổng quát, với độ chính xác cao.

– Chụp XQ bụng không sữa soạn

– Chụp đại tràng có cản quang.

– CT-Scan ổ bụng.

IV. CHẨN ĐOÁN XÁC ĐỊNH

Chủ yếu dựa vào các công thức sau:

Hội chứng tắc ruột ( khóc cơn, ói)+ tiêu máu = lồng ruột

Hội chứng tắc ruột      + u lồng = lồng ruột

Hội chứng tắc ruột      + X quang = lồng ruột

Hội chứng tắc ruột      + siêu âm = lồng ruột

Thực tế

– Khi trẻ có 3 triệu chứng: khóc thét từng cơn, nôn ói, tiêu máu và khối lồng

V. CHẨN ĐOÁN PHÂN BIỆT

– Hội chứng lỵ

– Viêm dạ dày, ruột.

– Búi giun.

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