small intestinal fibroma
Introduction
Introduction to small intestinal fibroma Small intestinal fibroma is a benign tumor that occurs in the small intestinal mucosal fibrous tissue. It is rare. River reported 163 cases of 1399 small intestine tumors, accounting for 11.6%. There are 5 groups of 1265 small benign small intestine tumors in China, accounting for only 0.39%. basic knowledge The proportion of illness: 0.012% Susceptible people: no specific population Mode of infection: non-infectious Complications: intestinal obstruction, gastrointestinal bleeding
Cause
Cause of small intestinal fibroma
(1) Causes of the disease
Small intestinal fibroma is a benign tumor of fibrous tissue in the small intestine. It is composed of fibroblasts and other tissue components. It can be divided into adenoma, fibroids and mucinous fibroids. Most of them are single-shot, the cut surface is grayish white, and weaving stripes are visible. The texture is tough.
(two) pathogenesis
The typical fibroids are composed of collagen fibers and fibroblasts. As its interstitial, only the blood vessels and some loose connective tissues around them, the fibers of the tumor tissue form bundles, interweaving, and the fibers contain slender fibroblasts. Generally, there is no mitotic figure, the appearance is nodular, and there is a coating composed of connective tissue around the tumor. The boundary is distinct, and the growth of the fibroid is slow, forming an induration, and the diameter generally does not exceed several centimeters.
The fibroids that occur in the small intestine wall are soft fibroids. The tumor cells are relatively large, the fiber components are few, and the arrangement is loose, forming a polypoid mass, called polypoid fibroma, which is different from the fibers that occur in the skin, fascia, etc. Tumor, which has many fiber components and few tumor cells, is called a hard fibroid.
The tumor located in the submucosal layer grows into the intestinal lumen and is a polypoid mass. It has no pedicle or pedicle, and can often cause intussusception and intestinal obstruction. The person who grows outside the cavity is located in the subserosal layer and is composed of fibrous connective tissue. Sometimes mucus-like changes can occur, which can grow to a larger volume. Tumors can cause contraction of the intestine due to gravity and strangulated intestinal obstruction. In some cases, intestinal perforation and peritonitis can be combined on the basis of acute obstruction.
Prevention
Intestinal fibroma prevention
1. Do not drink alcoholic beverages for a long time, quit smoking and drinking hobbies, do not overeat pickles, sour, spicy and irritating foods, and banned mildew foods. It is more important for people with chronic pharyngitis to develop good eating habits. If you are less than enough, eat more fresh fruits and vegetables.
Complication
Complications of small intestinal fibroma Complications, intestinal obstruction, gastrointestinal bleeding
1. Intestinal obstruction manifests as chronic progressive small bowel obstruction or acute complete obstruction, which is more common in the former.
2. Gastrointestinal hemorrhage Tumors with insufficient blood supply to produce erosion, ulcers, and bleeding.
Symptom
Symptoms of small intestinal fibroma Common symptoms Abdominal discomfort, pain, weight loss, abdominal distension, peritonitis, intestinal perforation, abdominal pain, bowel, stop, exhaust intussusception
Intestinal fibroma is often insidious, acutely rare, most patients are initially asymptomatic or ambiguous or non-specific, the diagnosis is often delayed, the clinical symptoms are mainly due to tumor caused by intussusception, intestinal torsion, etc. The resulting obstructive symptoms, small intestinal fibroma growth is slow, there is less gastrointestinal bleeding, and the tumor is generally not large, so abdominal mass is also rare.
1. Obstructive symptoms include chronic progressive small bowel obstruction or acute complete obstruction. The former is more common. Patients often have intermittent cramps. Colics are often aggravated after eating. When the gas passes through the obstruction site, the pain suddenly occurs. Alleviate or disappear, such symptoms are repeated, the next episode is often worse than the previous one, showing chronic, intermittent, progressive aggravation. When the course is longer, the patient often feels the gas in the abdomen, showing stomach, bowel or peristalsis. Wave, heard high sputum bow sounds, until the upper stage of the disease obstruction above the intestinal dilatation, contraction fatigue, the degree and frequency of pain are alleviated, and abdominal distension is more obvious, abdominal pain turns into persistent pain, about 1/4 of patients with abdominal pain Can be acute, abdominal pain, bloating, vomiting and stop venting, defecation and other symptoms.
Among the causes of obstruction, intussusception is the most common; secondly, it can be caused by tumor growth and intestinal stenosis; tumors growing outside the cavity are prone to intestinal torsion, causing strangulated intestinal obstruction, and abdominal pain can be persistent. , paroxysmal aggravation.
2. Gastrointestinal hemorrhage is located in the submucosal endoluminal tumor, which grows into the intestinal lumen, which can flatten the surface mucosa, cause local blood supply to be insufficient, and cause ulceration, ulceration, and bleeding. Most of the fecal occult blood test is positive, and major bleeding is rare. .
3. Others have abdominal discomfort, weight loss, anorexia, weight loss and other symptoms.
4. Signs of small bowel obstruction may have varying degrees of abdominal bulging, often seen intestinal type and peristaltic wave, intussusception can be licked and sausage-like mass, intestinal obstruction and intestinal perforation, there are signs of peritonitis, the whole abdomen may have tenderness , rebound pain, muscle tension.
Abdominal mass: rare, fibroids growing outside the cavity can grow to a larger volume, palpation of the abdomen can sometimes touch the swimming mass, the texture is more rigid and tough, the surface is smooth, the mass of the mass is large, and sometimes even disappears, generally In other words, the mass in the left upper abdomen often comes from the jejunum, and the lower abdomen often comes from the ileum.
Examine
Intestinal fibroma examination
When the gastrointestinal bleeding occurs, the fecal occult blood test is positive.
1. X-ray examination routine angiography positive rate is not high, abdominal plain film is easy to observe the presence or absence of intestinal obstruction, if found dilated bowel and liquid level, can roughly make a rough estimate of the lesion, the conventional digestive tract barium can be due to the intestine , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Check the occult blood; or use the barium enema for retrograde small bowel angiography to improve the diagnostic rate. The main manifestations of X-ray are:
(1) Filling defects: Tumors in the lumen and in the wall often produce clear filling defects.
(2) Shadow: The surface of the tumor is broken and there is a shadow, but it is generally not easy to display.
(3) signs of intussusception or obstruction.
(4) Intestinal fistula shift: Tumors that grow outside the lumen can be moved closer to the intestinal fistula.
2. Endoscopy examination for duodenal lesions with duodenoscopy, proximal jejunum can be used with fiberoptic enteroscopy, colon can be used at the end of the ileum, endoscopy can directly observe the lesion, and biopsy can be taken to confirm the diagnosis .
3. Selective superior mesenteric artery angiography Small intestinal fibroids are rare, but for fibroids with concurrent active hemorrhage, emergency angiography is a valuable diagnostic method that can show bleeding sites, even after bleeding stops. The value can show the abnormal blood vessel distribution of the tumor.
4. Ultrasound examination: patients with abdominal lumps and masses can also be used for B-ultrasound examination to observe the shape of the tumor and its relationship with the intestine. B-ultrasound is also convenient for finding extraluminal tumors.
Diagnosis
Diagnosis and diagnosis of small intestinal fibroma
Diagnostic criteria
The incidence of small intestinal fibroma is low, early lack of typical symptoms and signs, easy to be confused with other digestive diseases, often due to intestinal obstruction, gastrointestinal bleeding and treatment; currently lack of high accuracy, simple and easy, inexpensive, non-invasive Sexual diagnosis, so the diagnosis is very difficult, any unexplained chronic progressive small bowel obstruction, especially with gastrointestinal bleeding and abdominal mass, after the exclusion of stomach and large bowel disease, should think of this disease.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
3. Exploratory laparotomy If the above laboratory and other auxiliary examinations have not been clearly diagnosed, and clinically highly suspected small intestine tumors, early laparotomy should be performed to achieve the purpose of diagnosis and treatment.
Differential diagnosis
1. Duodenal ulcer can also have abdominal pain, gastrointestinal bleeding, nausea, vomiting, abdominal distension and other symptoms, in addition to the above symptoms can also cause pyloric obstruction symptoms, need to be differentiated from duodenal tumors, by X-ray examination, arteries Contrast, duodenal microscopy plus histological examination can be distinguished, if necessary, surgical exploration is required to confirm the diagnosis.
2. Small intestine hemangioma, small intestinal lipoma, small intestine leiomyoma, small intestine adenoma, small intestinal fibroid, their common clinical manifestations are abdominal pain, gastrointestinal bleeding, abdominal mass, due to tumor growth to the intestinal lumen caused by obstruction and Or intussusception, the identification between them depends on X-ray examination, endoscopy and biopsy, B-ultrasound and CT and necessary laparotomy.
