Intestinal cyst
Introduction
Brief introduction of intestinal cyst Intestinal balloon (pneumatosis cystoidsintestinalis, PCI), also known as cystic intestinal gas, is a submucosal or subserosal gastrocystic cyst of the gastrointestinal tract, which can affect all or part of the gastrointestinal tract from the esophagus to the rectum, but clinical The main onset in the small intestine and colon, can also occur in the mesentery, omentum, liver and stomach ligaments and other parts. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: volvulus, intestinal obstruction, intussusception
Cause
Intestinal air sac
Mechanical obstruction (30%):
(1) In the case of gastrointestinal obstruction, the pressure in the cavity is increased, the mucosa may be slightly damaged, and the gas can enter the lymphatic space of the mucosa to form a balloon swelling; Shen Weicai et al reported that 36 cases (78%) of a group of 46 cases of PCI in China suffered from Duodenal ulcer, and 30 cases with pyloric obstruction (65%), support this.
(2) obstructive emphysema and other lung diseases accompanied by severe cough, which increase the pressure in the alveoli, rupture of the alveoli, gas through the mediastinum along the fascia around the large blood vessels down to the peritoneum, and then along the mesenteric blood vessels to the intestinal wall, Some maneuver simulation experiments have been successful.
Nutritional disorders and chemical reactions (20%):
Some scholars believe that balloon swelling is a lymphatic vessel expansion. Normal lymph fluid contains alkaline carbonate. When it comes into contact with acidic products fermented in the intestinal lumen, it decomposes carbon dioxide, which is replaced by nitrogen in the blood. As a result, the nitrogen content in the balloon is more than 70%. It is known that pigs fed with polished rice can develop intestinal balloon swelling. Patients with vegetarian or pyloric obstruction are more likely to develop this disease, so the disease may be related to malnutrition. Some scholars have suggested that mechanical theory can not explain the process of air accumulation in lymphatic vessels, and the theory of nutritional deficiencies does not explain how air is excreted in lymphatic vessels. Therefore, it is believed that both mechanical obstruction and malnutrition can occur at the same time.
Bacteriology (10%):
It is believed that the gas-producing bacteria enter the submucosal layer of the intestinal wall and cause intestinal air swell disease. The gram-negative bacilli injected into the gastro-intestinal wall of the guinea pig develop intestinal air swell disease. If the baby dies from the disease, the baby can be cultured in the cyst. After the bacteria, the balloon swelling after oxygen therapy can disappear, suggesting that the onset may be related to the gas-producing anaerobic bacteria.
Pathological morphology and location (10%):
The diseased intestine can be seen scattered or densely saclike, with grape-like bulge, pale and transparent cystic lesions on the surface, ranging in size from a few millimeters to a few centimeters. Usually soft multiple submucosal lesions protrude into the intestine, and needle-punched vesicles are visible. The vesicle collapsed. Microscopic examination revealed a thin layer of connective tissue in the wall of the capsule. The inner surface of the capsule was covered with a single layer of flat or cuboidal epithelium, and there were multinucleated giant cells. The surrounding tissue of the cyst was hyperemia, edema, inflammatory cell infiltration, and sometimes Connective tissue hyperplasia and giant cell granuloma formation.
According to the location of the disease, it can be divided into small intestine type and large intestine type. The large intestine type is in the vicinity of sigmoid colon and spleen. The ascending colon and transverse colon are sometimes seen, but the rectum is not affected. The intestinal airbags associated with trichloroethylene are all large intestine. Type, small intestine type is related to stenosis of the digestive tract, most commonly seen in pyloric obstruction.
Prevention
Intestinal balloon swelling prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Intestinal cystitis complications Complications, intestinal torsion, intestinal obstruction, intussusception
Complications occurred in about 3% of cases, mainly intestinal torsion, intestinal obstruction, intussusception, intestinal bleeding and intestinal perforation.
Symptom
Intestinal balloon disease symptoms Common symptoms constipation diarrhea peritonitis bloody bloating abdominal pain in the post-acute reabsorption syndrome
Symptoms and signs: The symptoms of this disease are mild and vague, and may not be treated for a long time. Most intestinal air sacs are secondary to ulcers combined with pyloric obstruction, inflammatory bowel disease, gastrointestinal tumors and chronic intestinal obstruction. The main symptoms are The performance of the primary disease, a small number of idiopathic intestinal balloon disease, gastrointestinal symptoms may occur in a certain period of the disease, but also occasionally found in the physical examination or other related diseases, the main symptoms are blood in the stool and abdominal pain.
1. The blood in the stool is more common in the foamy bloody stool, and the mucosa at the top of the lesion under the submucosal tumor-like bulge is bleeding.
2. The abdominal pain is mostly in the lower abdomen or left rib, and the pain is mild.
3. Others may also have abdominal distension, constipation, diarrhea, weight loss and urgency, such as intestinal emphysema in the small intestine and extensive, can occur malabsorption syndrome.
Examine
Examination of intestinal cysts
1. The stool is mostly yellow loose stools, and there may be a small amount of red blood cells or pus cells, suggesting that intestinal inflammation exists.
2. Trichloride can be detected in the urine of TCE intestinal bladder.
3. Image inspection
(1) Abdominal plain film: 2/3 patients can be diagnosed by abdominal plain film, taking the flat position and the upright position flat film. The enema should be cleaned before the film is taken. When the air bag is small and the quantity is small, there is no characteristic performance. The airbag is large and large, especially under the serosa, it can be seen:
1 The edge of the inflatable bowel can be seen as a clustered or wavy continuous sac-like light-transmissive area, ranging in size from miliary to grape-sized, usually 1 to 2 cm in diameter.
2 When the balloon ruptures to form the pneumoperitoneum, the free film of the underarm can be seen in the standing piece, and the incidence is about 15% in the small intestine and about 2% in the colon.
The Chilaiditi's sign is the gas volume between the diaphragm and the liver or the fundus, which causes the sputum to rise, the liver or the fundus to descend, causing a considerable gap, and the inflated bowel tends to rise. And into the gap, the formation of meta-intestinal curvature, the intestinal curvature of the balloon swelling is more likely to form a meta-position, so that the sac-like translucent area of the intestinal wall shows clearer, this sign appears to be very helpful in the diagnosis of the disease.
(2) Barium enema: It can clarify the distribution and extent of the balloon swelling, which is characterized by a saclike translucent area of varying sizes at the edge of the filling lumen, which is distributed in clusters and located in various layers of the intestinal wall. Different from polyps and tumors, such as the airbag under the serosa, the light-transmitting area is often located outside the contour of the filling cavity. If the balloon protrudes into the intestinal lumen, a brighter polypoid filling can be seen at the edge of the intestinal lumen. Defect.
(3) Abdominal ultrasound: It is characterized by multiple and fixed linear or irregular high echo areas in the thickened intestinal wall. If high frequency ultrasound probe is applied, it is more conducive to diagnosis.
(4) Abdominal CT: It can display multiple cystic light-transmissive areas under the submucosa or subserosal, which is helpful for identification of other diseases in the abdomen and pelvis. For example, spiral CT multi-level scanning and oral contrast can improve the diagnosis of PCI. rate.
Colonoscopy can be used to determine the nature of the lesion, showing multiple cystic, grape-like bulges, pale and transparent cystic lesions on the surface, ranging in size from a few millimeters to a few centimeters, usually a soft multiple submucosal lesion Intestinal cavity, the color can be white or blue, the touch is weak and elastic. When the biopsy forceps or puncture needle is punctured, the airflow from the airbag can produce a sharp "squeaky" sound, and then the airbag collapses, accompanied by the cyst surface when infected. And the surrounding mucosa can have an inflammatory reaction, showing varying degrees of congestion, edema, erosion and so on.
Diagnosis
Diagnosis and identification of intestinal cyst
diagnosis
Because the symptoms are not specific, the diagnosis relies mainly on abdominal plain film, barium enema, colonoscopy, and the determination of TCE intestinal balloon swelling must meet the following conditions:
1. Long-term exposure to trichloroethylene environment.
2. Trichloride can be detected in the urine.
3. Intestinal balloon swelling is a large intestine type, and intestinal balloon disease is often obscured by the manifestations of associated diseases. It is rarely diagnosed alone, and is often found in surgery or special examinations.
Therefore, we must improve the vigilance of this disease, any gastrointestinal obstruction, inflammatory bowel disease should pay attention to the existence of this disease, X-ray examination found that there is free gas under the armpit, there is no signs of peritonitis, should consider the possibility of this disease, if found There is a meta-intestinal curve between the liver and the ankle to suggest PCI.
Differential diagnosis
1. Intestinal cysts The disease often occurs in the distal part of the ileum and is located in the intestinal wall. It is more common in children and is usually a single mass.
2. The identification of colon polyps and malignant tumors mainly depends on X-ray barium meal and endoscopy. When X-ray barium is examined, the filling defects caused by polyps or tumors do not change in size and shape due to the amount of tincture filling, and The density is higher than the filling defect caused by balloon swelling, and colonoscopy and biopsy can confirm the diagnosis.
3. The surgical exploration of intestinal lymphangioma has a similar appearance, but the capsule contains liquid.
