ABSTRACT

Non-bilious vomiting in preterm neonates discharged from neonatal intensive care units is a common complaint and is often associated with benign conditions such as gastro-oesophageal reflux. A neonate of 27 weeks gestation who presented later with vomiting owing to gastric outlet obstruction is described. He was discharged at 11 weeks of age and required re-admission 1 week later. He had persistent non-bilious vomiting from 7 weeks of age, failure to thrive and metabolic alkalosis. Clinical examination demonstrated visible gastric peristalsis, and hypertrophic pyloric stenosis was suspected. Ultrasound of the gastric pylorus and upper gastro-intestinal contrast studies were negative. Exploratory laparotomy after failure of conservative management revealed a thickened mucosal fold in the gastric pylorus, which was excised. Histopathology demonstrated inclusion bodies which are pathognomonic of cytomegalovirus infection. He was treated with valganciclovir for 6 weeks and was asymptomatic and thriving well at follow-up. Gastric outlet obstruction can be one of the manifestations of CMV infection of the gastro-intestinal tract. Diagnosis can be confirmed only by histopathology.

Abbreviations: BPD: bronchopulmonary dysplasia; CMV: cytomegalovirus; H&E: haematoxylin and eosin; IHC: immunohistochemistry; IHPS: infantile hypertrophic pyloric stenosis; NEC: necrotising enterocolitis; PCR: polymerase-chain reaction; VGP: visible gastric peristalsis.

摘要

从新生儿重症监护病房出院的早产儿非胆汁性呕吐是一种常见的主诉，通常与胃食管反流等良性疾病有关。描述了一个妊娠 27 周的新生儿，后来由于胃出口梗阻而出现呕吐。他在 11 周大时出院，1 周后需要重新入院。他从 7 周大开始出现持续的非胆汁性呕吐、发育迟缓和代谢性碱中毒。临床检查可见胃蠕动，怀疑有肥厚性幽门狭窄。胃幽门超声和上消化道对比研究均为阴性。保守治疗失败后剖腹探查显示胃幽门黏膜皱襞增厚，已切除。组织病理学显示包涵体是巨细胞病毒感染的特征。他用缬更昔洛韦治疗了 6 周，并且在随访中没有出现症状，并且表现良好。胃出口梗阻可能是胃肠道巨细胞病毒感染的表现之一。诊断只能通过组织病理学证实。

缩写： BPD：支气管肺发育不良；CMV：巨细胞病毒；H&E：苏木精和伊红；IHC：免疫组化；IHPS：婴儿肥厚性幽门狭窄；NEC：坏死性小肠结肠炎；PCR：聚合酶链反应；VGP：可见胃蠕动。