PDF(Pubmed)
Abstract：
Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor function and is often accompanied by secondary musculoskeletal issues. Severe scoliosis, a lateral curvature of the spine over 40 degrees, poses a significant challenge for individuals with CP, impacting their mobility and overall well-being. While the association between scoliosis and gastrointestinal complications is acknowledged, the occurrence of colonic volvulus with necrosis in the context of CP and severe scoliosis is rare and complex. This case report emphasizes the importance of clinical awareness in managing gastrointestinal complications in patients with CP and severe scoliosis. An 11-year-old female presented with gastroenteritis and a concurrent viral upper respiratory tract infection. She experienced complications such as greenish vomiting, hematemesis, abdominal distention, and constipation. The patient has a medical history of epilepsy and was diagnosed with quadriplegic CP at four months old due to viral meningitis. She is currently on anti-epileptic medications and receives regular follow-ups with neurology. Severe lumbar scoliosis of more than 50 degrees Cobb angle is also noted. Physical examination revealed dehydration, bilious content in nasogastric tube (NGT) aspiration, tender abdomen, and an empty digital rectal examination. Some laboratory findings showed elevated levels of erythrocyte sedimentation rate (ESR), prothrombin time (PT), blood urea nitrogen (BUN), and sodium, while albumin levels were decreased, and white blood cell (WBC) count was mildly elevated. Abdominal computed tomography (CT) with contrast showed a distended ascending colon with air and swirling of the mesentery. The distal half of the large bowel was not dilated, and fecal matter was present. The small bowel appeared to be collapsed, and there was moderate free fluid in the peritoneal cavity, indicating colonic volvulus involving the proximal large bowel. The patient underwent surgery, which involved deflating and removing the distended colon, resecting the gangrenous colon, and performing an ilio-sigmoid anastomosis to restore gastrointestinal continuity. Postoperatively, the patient received close monitoring in the pediatric intensive care unit (PICU), received total parenteral nutrition (TPN) for five days, gradually progressed feeding, and showed overall improvement in her condition. In conclusion, this case report highlights a rare occurrence of colonic volvulus in a patient with CP and severe scoliosis. It emphasizes the complex relationship between neurological and musculoskeletal disorders in gastrointestinal complications. A multidisciplinary approach is important for optimal management. It shows the importance of musculoskeletal factors in patients with neurological conditions. Overall, it contributes to the medical literature and emphasizes tailored management strategies for gastrointestinal issues in such patients.
摘要：
脑瘫（CP）是一种影响运动功能的神经发育障碍，通常伴有继发性肌肉骨骼问题。严重脊柱侧弯,脊柱的横向弯曲超过40度，对患有CP的个人构成了重大挑战，影响他们的流动性和整体福祉。虽然脊柱侧弯和胃肠道并发症之间的关联是公认的，在CP和严重脊柱侧凸的背景下发生结肠扭转伴坏死是罕见且复杂的。此病例报告强调了临床意识在治疗CP和严重脊柱侧凸患者胃肠道并发症中的重要性。一名11岁女性出现胃肠炎和并发病毒性上呼吸道感染。她经历了绿色呕吐等并发症，呕血,腹胀,还有便秘.该患者具有癫痫病史，并在四个月大时因病毒性脑膜炎而被诊断为四肢瘫痪性CP。她目前正在服用抗癫痫药物，并定期接受神经病学随访。还注意到超过50度Cobb角的严重腰椎侧凸。体格检查显示脱水,鼻胃管（NGT）抽吸术中的胆汁含量，温柔的腹部，还有一个空的直肠指检.一些实验室发现显示红细胞沉降率（ESR）升高，凝血酶原时间（PT），血尿素氮(BUN),还有钠,而白蛋白水平下降，白细胞（WBC）计数轻度升高。对比腹部计算机断层扫描（CT）显示升结肠扩张，空气和肠系膜旋转。大肠远端一半没有扩张，还有粪便.小肠似乎塌陷了,腹膜腔有中等程度的游离液，提示结肠扭转累及近端大肠。病人接受了手术,其中包括放气和切除扩张的结肠，切除坏疽结肠,并进行髂乙状结肠吻合术以恢复胃肠道的连续性。术后,患者在儿科重症监护病房（PICU）接受了密切监测，接受全胃肠外营养（TPN）五天，逐步推进喂养，并显示她的病情总体改善。总之,本病例报告突出显示1例CP合并重度脊柱侧凸患者罕见发生结肠扭转.它强调胃肠道并发症中神经系统和肌肉骨骼疾病之间的复杂关系。多学科方法对于优化管理很重要。它显示了神经疾病患者肌肉骨骼因素的重要性。总的来说,它有助于医学文献，并强调针对此类患者的胃肠道问题量身定制的管理策略。
