congenital colonic stricture and atresia
Introduction
Introduction to congenital colon stenosis and atresia Congenital colonic atresia and stenosis (congenitalstenosisandatresiaofcolon) is rare, and was first reported by Bininger in 1673. In 1922, Gaub first used colostomy to treat the deformity. In 1947, Potts used the first-stage anastomosis to treat the disease successfully. Because the disease is not common, there is still no systematic comprehensive report, which is limited to individual cases. In the digestive tract atresia and stenosis, colonic atresia and stenosis (colonicatresiaandstenosis) is relatively rare, generally accounting for about 10%, and only gastric atresia is more rare. basic knowledge Sickness ratio: 0.0001% Susceptible people: infants and young children Mode of infection: non-infectious Complications: peritonitis
Cause
Congenital colon stenosis and atresia
(1) Causes of the disease
1. Intestinal cavitation in the embryonic period According to Tandie's theory, it is believed that before the fifth week of embryonic development, the digestive lumen has a complete intestinal tube covered by epithelial cells. After that, the epithelial cells grow extremely fast, and the intestinal lumen is proliferated by epithelial cells. Occlusion, called the parenchymal phase, later appeared vacuoles in the middle, forming cystic voids and merging with each other. At 12 weeks of embryonic recanalization of the intestine, such as incomplete voids, forming a occlusion or stenosis, in recent years The doctrine raises some questions, such as type III small intestine or colon atresia can not be explained by the Tandler theory.
2. Fetal mesenteric blood circulation is damaged due to damage, mesenteric vessel branch malformation or occlusion, fetal intra-abdominal infection such as fecal peritonitis can lead to colonic atresia and stenosis, Louw et al. studied the cause of colonic atresia, adopted a fetus in 1955 The dog's litter is tested. They ligature the small mesenteric blood vessels of the litter, which can cause this small intestine atresia, and this segment of the small mesentery is also defective. It is suggested that the gastrointestinal atresia is caused by obstruction of the mesenteric membrane during embryonic period. The cause of the injury may be intestinal torsion, poor intestinal rotation, internal hemorrhoids or vascular malformations.
Abram et al (1968) used 80 days of sheep fetus to test the tear of the mesentery of the sheep, almost 100% can cause type I, II or III intestinal atresia, so the colonic atresia and stenosis may occur during embryonic development. Any one of them exists.
(two) pathogenesis
1. Pathological pathology and small intestine atresia are very similar. According to the degree and shape of the atresia, it can be type 3:
Type I diaphragm atresia: Membrane septum in the intestinal lumen, membranous septum colonic cavity is divided into the far and near side, the two parts are not connected to each other; or a small hole in the center of the diaphragm communicates to form a colonic stenosis.
Type II cord-like atresia: the mesentery is intact, the intestine is far, and the proximal end is blind.
Type III mesenteric defect: the intestine is far, the proximal end is the blind end of the separation, and the mesentery also has a V-shaped defect.
In the ascending, the intestinal atresia and stenosis of the transverse colon are mostly type III, and the intestinal atresia and stenosis occurring far beyond the splenic curvature are more common in type I and II.
The proximal intestine of the atresia is obviously dilated, hypertrophic, and the peristaltic function is poor. The distal intestinal tube collapses, shrinks and becomes thinner, and there is a white hard mucus substance in the intestinal cavity. If the ileocecal valve is intact and the atresia is located far away from the colonic hepatic curvature, then The formation of blind sputum, the ileocecal valve between the ileocecal valve and the atresia is highly dilated, the intestinal wall is thin, ischemic, necrotic and even perforated, due to a part of intestinal atresia and stenosis occurred in the third trimester of pregnancy, about 10% to 20% of colonic atresia The child can expel the fetus shortly after birth.
2. Combined with abnormal colonic atresia often associated with skeletal deformities such as multiple fingers and clubfoot, eye and cardiovascular malformations; abdominal wall, umbilical bulge and other abdominal wall deformities, congenital megacolon, duodenum and Small intestine atresia.
Prevention
Congenital colon stenosis and atresia prevention
1, early pregnancy, avoid fever and cold. Women who have had high fever in early pregnancy, even if the child does not have obvious appearance deformity, brain tissue development may be adversely affected, manifested as mental retardation, poor learning and reaction ability, this mental retardation can not be restored. Of course, fetal fever caused by high fever is also related to the sensitivity of pregnant women to high fever and other factors.
2. Avoid getting close to dogs and cats. Few people know that cats with bacteria are also a source of infectious diseases that are a great threat to fetal malformation, and cat feces are the main route of transmission of this malignant infectious disease.
3. Avoid women who wear makeup every day. The survey shows that the incidence of fetal malformations in heavy makeup is less than 1.25 times that of heavy makeup. The main adverse effects on fetal malformation are arsenic, lead, mercury and other toxic substances contained in cosmetics, which affect the normal development of the fetus. Secondly, some of the ingredients in the cosmetics are exposed to ultraviolet rays in the sun to produce teratogenic aromatic amine compounds.
4, to avoid mental stress during pregnancy. Human emotions are controlled by the central nervous system and the endocrine system. One of the endocrine corticosteroids is closely related to human mood changes. When pregnant women are emotionally stressed, adrenocortical hormone may block the fusion of a certain tissue of the embryo. If it occurs during the first 3 months of pregnancy, it will cause malformations such as cleft lip or palate.
5. Avoid drinking alcohol. Pregnant women drink alcohol, alcohol can enter the developmental embryo through the placenta, causing serious damage to the fetus. Such as a small head, very small ear and nose and a wide upper lip.
6, avoid eating mold and vegetarian food. Experts pointed out that if pregnant women eat food contaminated with mycotoxin (mildew food), mycotoxins can cause fetal chromosome breaks in the fetus through the placenta.
Complication
Congenital colon stenosis and atresia complications Complications peritonitis
Colonic atresia and stenosis often complicated by intestinal perforation or diffuse peritonitis.
Intestinal perforation refers to the process in which intestinal lesions penetrate the intestinal wall and cause intestinal contents to overflow into the peritoneal cavity. It is one of the serious complications of many intestinal diseases, causing severe diffuse peritonitis, mainly characterized by severe abdominal pain, abdominal distension, and peritonitis. Symptoms and signs can cause severe shock and death.
Acute peritonitis is a serious disease common to surgery caused by bacterial infections, chemical stimuli or injuries. Most are secondary peritonitis, original organ infections in the abdominal cavity, necrotic perforation, trauma and so on.
Symptom
Congenital colonic stenosis and atresia symptoms Common symptoms Intestinal atresia, intestinal stenosis, intestinal bloating, dehydration
In the history of colonic atresia, the mother may have too much amniotic fluid during pregnancy. The newborn has no meconium discharge within 48 hours after birth, abdominal distension, vomiting, vomit contains bile, and there is dehydration, and the symptoms are not obvious at birth, and there is a low position after feeding. Complete intestinal obstruction, progressive abdominal distension, individual sick children have a history of normal fetus 1 to 2 days after birth, late dehydration and electrolyte imbalance with aspiration pneumonia.
The symptoms of colon stenosis are related to the degree of stenosis. The symptoms of severe stenosis are the same as those of atresia. Symptoms of mild stenosis are relieved, and the course of disease is longer. The symptoms of low incomplete intestinal obstruction gradually appear several weeks after birth, such as progressive aggravation of symptoms after feeding, vomiting. For intermittent, vomit is mostly milk juice and food residue, occasionally vomiting bile, full abdominal distension can be seen in the bowel type, bowel sounds hyperthyroidism, difficulty in defecation, stool is mostly thin or slender, the child is more nutritious Poor and anemia, easily misdiagnosed as congenital megacolon.
Colonic atresia is not easy to distinguish from low intestinal obstruction caused by other causes. Most of the dilated bowel and liquid level can be seen in the abdominal plain film. The extremely dilated colon in the proximal part of the atresia shows a huge liquid level or gas-filled intestinal fistula. It has diagnostic value when showing fetal colon, can determine the atresia, show the location and type of stenosis, and judge the function and extent of the proximal dilatation of the intestine in the stenosis.
Examine
Congenital colon stenosis and atresia
X-ray inspection
(1) Abdominal plain film: Children with colonic atresia often find multiple dilated intestinal fistulas with a liquid-gas plane. A large liquid-gas plane in a highly dilated intestinal fistula is often an indication for the diagnosis of transverse colon atresia. Although the expansion of the small intestine is generally not obvious, it is difficult to distinguish whether the obstruction occurs in the small intestine or the colon on the X-ray film.
(2) Enema: For the differentiation of colonic atresia, congenital megacolon, meconium intestinal obstruction and small intestine atresia are important. In the case of colon atresia, the intestinal colon and colon filling are incomplete, and I can be found in type I atresia. The wind bag sign, that is, the contrast agent pushes the locking diaphragm to the proximal end to form a bag shape. When the colon is narrow, the contrast agent can be seen from the distal small and thin colon to the proximally expanding colon, and sometimes the small narrow is meconium. Blockage is manifested as colonic atresia.
2. Fiber colonoscopy or sigmoidoscopy
The intestinal stenosis caused by other lesions of the colon can be excluded, and the distal stenosis can be observed, and the distance between the stenosis and the anus can be calculated to provide a basis for the operation.
Diagnosis
Diagnosis of congenital colonic stenosis and atresia
Colonic atresia and stenosis should be differentiated from congenital megacolon, ileal atresia, and congenital left small colon syndrome.
