Congenital gastric muscle layer defect
Introduction
Introduction to congenital gastric wall muscle defect Congenital gastric defect (congenitaldefects of gastric musclemusculature) refers to the muscular wall defect caused by embryonic developmental disorders. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible population: newborn Mode of infection: non-infectious Complications: gastric perforation peritonitis shock
Cause
Congenital gastric wall muscle defect
(1) Causes of the disease
There are several theories about the causes of congenital gastric wall muscle defects.
1. Abnormal embryonic development: During embryonic development, the ring muscle of the stomach wall first occurs, starting at the lower end of the esophagus, gradually developing to the fundus and the large curved part of the stomach. At the 9th week of the embryo, the oblique muscle appears, and finally the longitudinal muscle is formed. Developmental disorders at a certain stage can lead to muscle wall defects in the stomach wall.
2. Gastric wall ischemia: In perinatal respiratory disorders, hypothermia and hypoxemia, the baby can re-distribute the modern compensatory blood, increasing the blood supply to vital organs such as the brain and heart, while the stomach and intestines The blood supply is significantly reduced, causing ischemic necrosis of the gastrointestinal tract.
3. Increased intragastric pressure is the main factor that promotes perforation: The submucosal tissue of the newborn is fragile, the elastic fiber is underdeveloped, and the stomach is prone to gastric dilatation. If the stomach contents of the child are delayed, breastfeeding, sucking and crying, swallow Air can cause the intragastric pressure to rise, the stomach to expand, and finally the rupture of the muscle wall defect in the stomach wall.
(two) pathogenesis
The main pathological changes are the muscular wall defect of the stomach wall. The most common site is the large curvature of the stomach, which is the anterior wall of the stomach, the cardia, the bottom, the small curve, the posterior wall, the pylorus, and the size of the defect. The defect only has the mucosa, the submucosa and The serosal layer, any factors that increase the intragastric pressure after birth, such as: swallowing air, milk or crying, vomiting, gastric lavage, mask pressure, oxygen, etc. can cause sudden increase in gastric pressure, lesions outward Prominent, room-like, if the pressure continues to increase, it will affect the blood circulation, leading to necrosis of the wall of the muscle layer, the edge of the perforation is irregular, black and yellow necrosis, mucosa near the perforation, abnormal muscle layer and blood vessels, perforation edge The muscle layer is gradually thinned, and the muscle layer is interrupted at the perforation. The mucosa at the proximal hole is thinned, the submucosa is thin, the gastric gland is poorly developed, and the size of the blood vessel wall in the mucosa and submucosal tissue is abnormal, which is a monolayer. Blood vessel congestion, dilatation, hemorrhage, no inflammatory changes, perforation size, and multiple.
Prevention
Congenital gastric wall muscle defect prevention
Do a good job of pregnancy, prevent premature birth, intrauterine hypoxia; prevent perinatal respiratory disorders, prevent hypothermia and hypoxemia; actively treat various perinatal diseases, and promote rehabilitation of children.
Complication
Complications of congenital gastric wall muscle defect Complications, gastric perforation, peritonitis, shock
Gastric perforation, peritonitis, intestinal paralysis, water and electrolyte disorders, shock.
Symptom
Congenital gastric wall muscle defect symptoms Common symptoms Gastric wall muscle defect Acute abdomen abdominal distension Mobile dullness Peritonitis Bowel sound disappears Intestinal intestinal paralysis Dehydration weakness
Congenital gastric wall muscle defect is not easy to diagnose before perforation. The general condition of the child is good after birth. There is no obvious prodromal symptoms. There is a history of normal fetus, usually 3 to 5 days after birth, and some cases as early as the 2nd day. Or as late as the 8th day, the onset is urgent, sudden acute abdomen manifestation, refusal to milk, vomiting, vomit is yellow-green or brown, low crying, mental wilting, progressive bloating, difficulty breathing, bruising, late can appear Peritonitis, fever, intestinal paralysis, dehydration, electrolyte imbalance, shock, physical examination can be found shortness of breath, bowel sounds disappear, abdominal distension is obvious, abdominal wall venous engorgement, abdominal, waist, scrotal skin edema, liver dullness disappears, abdominal mobility Positive voiced sound, perforation 12h around the abdominal wall may appear purple, shiny and edema, mild muscle tension and other peritonitis manifestations, abdominal puncture can suck out gas or pus, feces, etc., perforation often occurs within 1 week after birth, most in 3 ~5 days.
Examine
Examination of congenital gastric wall muscle defect
Peripheral blood picture infection was significantly increased in peripheral blood leukocytes; blood biochemistry should check blood sodium, potassium, chlorine, calcium and blood pH; when peritonitis occurs, peritoneal puncture leukocytes often >1000/mm3, mainly granulocytes, ascites pH 7.35 ~ 7.24 (normal 7.45).
Regular B-ultrasound, X-ray examination, including chest X-ray, abdominal plain film.
The diagnosis of congenital gastric wall muscle defects depends on surgery and pathological diagnosis, but X-ray examination is still the preferred method for the examination of this disease. It is of great significance for early detection of gastric perforation and early surgical treatment. X-ray examination can find pneumoperitoneum. In the liquid and abdomen, the following signs can be seen in different body positions: saddle sign, disappearance of gastric sac, sign of pencil line, football sign, sacral ligament sign, congenital gastric wall muscle defect and gastric perforation, characteristic X Line performance, the abdominal plain film can be seen abdominal distension, gas increase, showing "soccer sign"; standing abdomen plain film under the armpits can see free gas, diaphragmatic muscles, traversing the abdomen of the gas-liquid plane, the disappearance of gastric sacs, etc.; Lateral position see a large amount of free gas under the abdominal wall and show the contour of the leading edge of the intestine, and see the long liquid level, the above characteristic X-ray performance, for early diagnosis, timely surgery, is very important for the prognosis of this disease.
Diagnosis
Diagnosis and diagnosis of congenital gastric wall muscle defect
Diagnostic criteria
Early neonates, especially premature infants, suddenly develop progressive bloating 3 to 5 days after birth, accompanied by vomiting, difficulty breathing, cyanosis, liver dullness disappears, bowel sounds disappear, should consider the disease, if perforated, abdomen X There are a lot of gas and liquid in the line-up position. The diaphragm is elevated in the standing position. There is a lot of free gas in the abdomen and the abdomen. The shadows of the liver and spleen on both sides are moved to the sides of the middle and abdomen. The stomach bubbles disappear, the intestinal inflated is less, and the liquid is concentrated. In the lower abdomen, a liquid level across the entire abdomen can be seen. When the perforation or perforation is small, only the gastric dilatation is weak, the shape is special, and the barium meal is angiographically displayed, indicating that the gastric peristalsis is weak, the expansion is obvious, and the pyloric opening is delayed.
Differential diagnosis
1. Perforation caused by gastric perforation, mechanical damage, intestinal obstruction, etc. caused by other causes in the neonatal period.
2. Children with meconium peritonitis often have no meconium, or less meconium discharge, X-ray shows intestinal adhesion, intestinal lumen inflation, multiple fluid level, intra-abdominal, less free gas under the armpit, normal stomach bubble Sometimes calcification is visible.
