Cecal granuloma
Introduction
Introduction to cecal granuloma The cecum is the thickest, shortest, and most accessible segment of the large intestine. In the right rear of the duodenum, a part of the cecum can be seen. When the cecum is opened, two long blind tubes are seen, with the blind end facing backwards. The cecal granuloma has cecal amoebic granuloma and schistosomiasis granuloma, a complication of chronic colitis caused by Entamaeba Histolytica. The ileocecal schistosomiasis granuloma is a late stage disease of intestinal schistosomiasis. The schistosomiasis egg deposition site is mainly the terminal ileum except the colon. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: amoebic liver abscess carbamate pesticide poisoning amoebic enteritis opioid poisoning cypress-cha syndrome Brenneman syndrome Barrett syndrome galactosemia fulminant hepatic failure whipworm disease Syndrome fulminant hepatitis-like syndrome constipation pyrazolone poisoning Barrett esophagus achalasia sputum poisoning diphenhydramine poisoning Proteus food poisoning castor bean poisoning paraquat poisoning hepatitis C virus enteropathy limb dermatitis syndrome bowel Intestinal torsion syndrome
Cause
Causes of cecal granuloma
Long-term unhealed lesions (30%):
The amoebic granuloma of the cecum is caused by long-term unhealed lesions, resulting in a large amount of fibrous tissue, inflammatory infiltration and edema of the mesentery and intestinal wall, and formation of a granulomatous mass, and intestinal stenosis or dyskinesia of the intestinal wall causing intestinal obstruction.
Intestinal wall rupture (30%):
The schistosomiasis granuloma is a schistosomiasis in which the schistosomiasis enters the intestinal wall tissue around the blood vessels through the venous rupture of the intestinal wall, especially in the submucosal layer. The eggs cause leukocyte infiltration in the intestinal wall, and pseudo-nodule formation. Fibrous tissue hyperplasia, advanced intestinal wall fibrosis thickening, mucosal proliferation to form granuloma.
Prevention
Cecal granuloma prevention
Take care to prevent infection with amoeba and trematode. Pay attention to food hygiene. Patients with chronic diarrhea should be promptly examined, such as patients with intestinal amebiasis or those with cysts who must be thoroughly treated and isolated from the intestine. For the catering industry, personnel should be temporarily transferred from work. It is also important to vigorously eliminate flies and cockroaches and strengthen manure management.
1. The spread of the disease is mainly caused by contaminated hands, flies, and cockroaches bringing the cysts of amoeba to food and oral infection. However, most people have no obvious clinical symptoms after infection and become asymptomatic worms; only a few people with low body resistance have clinical symptoms.
2. A large number of amoebic trophozoites can be excreted in the feces of patients with acute amebiasis, but the trophozoites die quickly in the external environment, so the acute infection is generally less. For chronic or asymptomatic worms, the amoeba sac excreted in the feces is more resistant to the external environment, and the general disinfectant cannot kill them. Therefore, these chronic patients, especially the asymptomatic amoeba carrier, are important sources of infection and can transmit the disease to others.
3, amoeba protozoa is mainly fecal-oral infection, the mouth to the anus sexual intercourse has more opportunities to contact this source of infection, thereby infecting the amoeba.
Complication
Cecal granulomatous complications Complications amoebic abscess carbamate pesticide poisoning amoebic enteritis opioid poisoning cypress-cha syndrome Brenneman syndrome Barrett syndrome galactosemia fulminant hepatic failure whipworm disease Buka synthesis Illness fulminant hepatitis-like syndrome constipation pyrazolone poisoning Barrett esophagus achalasia sputum poisoning diphenhydramine poisoning Proteus food poisoning castor bean poisoning paraquat poisoning hepatitis C virus enteropathy limb dermatitis syndrome intestinal Flora toxin syndrome
ADH hypersecretion syndrome, amebic liver abscess, carbamate pesticide poisoning, amoebic bowel disease, opioid poisoning, cypress-check syndrome, Brenneman syndrome, Barrett syndrome, galactose blood Symptoms, fulminant hepatic failure, whipworm disease, Buka syndrome, fulminant hepatitis-like syndrome, constipation, pyrazolone poisoning, Barrett's esophagus, achalasia, sputum poisoning, diphenhydramine poisoning, deformation Bacteria food poisoning, castor poisoning, paraquat poisoning, hepatitis C virus, enteropathic cutaneous dermatitis syndrome, intestinal flora disorders, intestinal torsion syndrome, acute intestinal obstruction and other diseases.
Symptom
Symptoms of cecal granuloma Common symptoms Abdominal pain Diarrhea Cecum amoebic granuloma Right lower abdominal pain Low intestinal obstruction Right lower abdomen can touch soft... Inflammatory granulomatous infectious granuloma
1. The cecal amoebic granuloma is localized abdominal pain and intermittent diarrhea. The occult blood in the feces is sometimes positive, and the right lower abdomen can reach the soft sausage-like mass.
2. The schistosomiasis granuloma in the ileocecal area is accompanied by a chronic low intestinal obstruction in addition to the right lower quadrant. The course of the disease often lasts for several months, and then symptoms of acute intestinal obstruction appear.
Examine
Examination of cecal granuloma
1. Fecal examination:
(1) Live trophozoite examination method: The trophozoite of the activity is checked by the direct smear method of physiological saline. The container is required to be clean, the fecal sample is fresh, the faster the inspection, the better, and the cold season should pay attention to the insulation during transportation and inspection. Take a clean glass slide, add 1 drop of normal saline, then take a small amount of feces with a bamboo stick, apply it in physiological saline, add a cover slip, and then place it under a microscope. Microscopic examination revealed red blood cells with more sticky clusters and fewer white blood cells in the mucus, sometimes showing Charcot-Leydencrystals and active trophozoites.
(2) Encapsulation examination method: The iodine liquid smear method is commonly used in clinical practice, and the method is simple and easy. Take a clean glass slide, add 1 drop of iodine solution, then take a small amount of fecal sample with bamboo stick, apply it to the iodine solution and cover the slide, then place it under the microscope to identify the characteristics and number of nuclei. .
2. Amoeba culture:
There are a variety of improved artificial media, such as Rockwell's solution, eggs, serum medium, nutrient agar serum saline medium, agar protein biphasic biphasic medium and the like. However, the technical operation is complicated and requires certain equipment, and the positive rate of amoebic artificial culture in most subacute or chronic cases is not high, and it seems that it is not suitable for routine examination of amoeba diagnosis.
3. Organizational inspection:
The mucosal ulcer was directly observed by sigmoidoscopy or fiberoptic colonoscopy, and the biopsy or scraping smear was performed, and the detection rate was the highest. It has been reported that sigmoid colon and rectal lesions account for about two-thirds of patients with symptoms. Therefore, all suspected patients should be allowed to have colonoscopy, scraping smear or biopsy. The trophozoites must be taken from the edge of the ulcer, and it is advisable to have a partial bleeding after clamping. In addition to the attentional features of the puncture fluid examination, it should be taken from the wall of the abscess, which is easier to manage.
Diagnosis
Diagnosis and diagnosis of cecal granuloma
diagnosis:
1. The cecal amoebic granuloma often undergoes pathological examination after resection, and it is found that there are most trophozoites and cysts in the diseased tissue to confirm the diagnosis.
2. The schistosomiasis granuloma in the ileocecal area is followed by a history of contact with the infected area and a positive test for fecal eggs. A fairly accurate diagnosis can be obtained.
The cecal amoebic granuloma, sputum enema can only be proved as cecal lesions and can not be identified, so many misdiagnosed as cancer and surgical resection, sometimes mainly manifested as chronic intestinal obstruction can be misdiagnosed as intestinal tuberculosis or localized colitis, often removed After the pathological examination, it was found that there were most trophozoites and cysts in the diseased tissue to confirm the diagnosis.
