Ascaris intestinal obstruction
Introduction
Introduction to aphid intestinal obstruction Aphid intestinal obstruction is caused by the mechanical blockage of the intestinal tract caused by agglomeration of aphids. It is the first in non-neoplastic occlusive intestinal obstruction, mostly simple and partial intestinal obstruction. Under normal circumstances, the aphids parasitic in the intestine are scattered, parallel to the longitudinal axis of the intestine, and generally do not cause obstruction. However, when the mites multiply or some physiological changes occur in the human body, such as elevated body temperature, diarrhea, intestinal dysfunction, allergic constitution, and increased irritation caused by various stimuli or insufficient dose of deworming agents, aphids can be induced. The turmoil, gathering, and kinking into a group caused blockage of the intestinal lumen. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: fecal-mouth transmission complication:
Cause
Causes of aphid intestinal obstruction
(1) Causes of the disease
Under normal circumstances, the aphids parasitic in the intestine are scattered, parallel to the longitudinal axis of the intestine, and generally do not cause obstruction, but when the aphids multiply or some physiological changes occur in the human body, such as elevated body temperature, diarrhea, intestinal dysfunction , allergic physique and various stimuli caused by increased intestinal peristalsis or insufficient dose of deworming agents, can induce locust commotion, aggregation, kinking into a group, causing intestinal blockage, causing mechanical intestinal blockage of the number of mites from dozens Up to several thousand, some authors reported that 20,097 aphids were removed from the intestine of a patient. In addition, the metabolites of aphids stimulated the intestinal wall to cause spasm, which also promoted the occurrence of obstruction and the number of aphids required for spastic obstruction. Not many, sometimes only 1 to 2, mites and intestinal fistula can also cause intussusception.
(two) pathogenesis
1. The pathogenesis is aggravated by agglomerates that are twisted into a group. Due to mechanical stimulation and the toxins produced by aphids, the intestinal tract, intestinal contents cannot pass through the intestines, and the intestinal tract is narrow, or a large number of intestinal tracts cause a series of intestinal tracts. And the pathological and physiological changes of the whole body, the adult is mainly parasitic in the middle cavity of the jejunum, and its toxic effect may be the absorption of antigen (from living or dead aphids), causing LgE-mediated allergic reaction, and the aphid can mechanically damage the intestinal mucosa of the host. Its metabolites can also stimulate, damage the local mucosa, causing spasmodic contraction and ischemia of the smooth muscle, which can cause malnutrition due to intestinal mucosal damage.
When the number of insects is large, it often twists into a mass in the intestinal lumen, causing intestinal obstruction. The proximal ileocecal part of the obstruction is common. When the number of insects is small, intestinal obstruction can also occur, and intussusception or intestinal torsion can also be caused.
The mites are like drilling and smashing. When they are stimulated, they are easily irritated in the intestine and cause various serious complications. Drilling into the biliary tract causes biliary ascariasis to be particularly common and serious. When the mites invade the cystic duct or the intrahepatic bile duct, they can continue. Bacterial infection caused by acute cholangitis, cholecystitis, or acute hemorrhagic necrotizing pancreatitis, can cause liver abscess when deep into the intrahepatic bile duct, inflammation or aphid itself can make the gallbladder or biliary tract perforation, causing biliary peritonitis, drilling Aphids entering the biliary tract can sometimes withdraw or switch direction and then return to the small intestine or spit out from the mouth, even or death left in the common bile duct, can also drill into the appendix, surgical wounds, abdominal wall abscess, gastrointestinal decompression tube, T-shaped drainage Tube, eustachian tube and other parts, even into the trachea caused by asphyxia, occasionally into the brain, spinal canal, nose, kidney, bladder, prostate, urethra, uterus, vagina and other places caused by the corresponding lesions.
Aphids ectopically parasitize and ovulate, if left in some organs (such as liver, lung, pancreas, peritoneum and mesentery) can form granuloma of eggs, if left in the biliary tract, gallbladder, then eggs or mites The body is the core and can form stones gradually.
2. Pathology
(1) Intestinal changes: gas and fluid accumulation in the intestinal lumen of the upper segment of the obstruction, dilatation of the intestinal lumen, enhanced intestinal movement, attempt to overcome obstruction, at this time only the obstruction of the intestinal lumen, no obstacles to blood circulation, simple Intestinal obstruction, if continued to develop, the blood circulation disorder and necrosis of the intestinal wall, become purple-black, this is called strangulated intestinal obstruction, when the intestinal lumen is dilated or paralyzed, the mites are stimulated in the intestines, such as drilling The weakness of the intestinal wall causes peritonitis or a single peritoneal abscess.
(2) systemic changes: mainly dehydration and hydroelectric medium disorder, toxin absorption and infection, such as intestinal toxins in the intestinal cavity penetrate into the abdominal cavity, causing peritonitis and then absorbed into the blood, resulting in systemic poisoning.
Prevention
Prevention of aphid intestinal obstruction
Comprehensive measures should be taken, including controlling the source of infection, conducting census and general treatment, and areas with an infection rate of more than 70% can be treated collectively, reducing the density of eggs in the land, reducing transmission opportunities, strengthening manure management, changing personal hygiene habits, and before meals. After washing your hands, do not eat lettuce or unwashed sweet potatoes, carrots, etc., schools, kindergartens can regularly take anthelmintic drugs to prevent infection, the family can also give children an anthelmintic every 1 quarter to prevent .
Complication
Aphid intestinal obstruction complications Complication
The mites are blocked for too long, and a small number of patients may have intestinal wall ischemia, necrosis, perforation, etc., resulting in a large number of mites entering the abdominal cavity leading to various complications.
Symptom
Symptoms of aphid ileus common symptoms abdominal distension paroxysmal abdominal pain nausea aphid intestinal obstruction aphid infection visceral obstruction abdominal cramps abdominal muscle tension white blue gray or black speckled eyeball spots
The early stage of aphid intestinal obstruction is mostly paroxysmal abdominal pain, abdominal distension, nausea, vomiting, sometimes spit out or aphid and other symptoms. The abdominal pain is mostly colic. When the body is examined, the abdominal muscle tension is not obvious. The patient felt a cord-like or sausage-like mass in the umbilical cord or the right lower quadrant. The finger pressure had a high or low unevenness or a sense of movement. The mass may have a slight movement. In the advanced stage, complete obstruction may occur, and the obstruction site is mostly located at the end of the ileum.
Examine
Examination of aphid intestinal obstruction
1. Feces can be taken from 5 to 10 g of feces, and the eggs can be detected in the feces by direct smear method, thick smear method or saturated saline flotation method. If only males are parasitic, no insects can be found in the feces. egg.
2. The blood picture checks for eosinophilia in the surrounding blood.
3X-ray examination of the intestinal mites twisted into a mass caused by mechanical obstruction, plus the local stimulation of aphids caused paralysis, so the X-ray abdominal plain film image shows:
1 obstruction occurs mostly in the small intestine, and more incomplete obstruction.
2 Standing lobes sometimes have wavy or coarse granules uneven above the liquid level, and the density is uneven. It is a typical "hump" sign, which is mostly caused by insects.
3 Most patients have various postures on the ventral lobes, or arranged in a strip shape, or twisted into a group, and the cross-section of the coarse-grained worms is similar in size, and the shape is constantly changing. The worm body is 5 to 6 mm thick, such as The swallowing of the insect body can be seen as a linear or point-like shadow in the worm. If the worm is swallowed, after the patient's intestine is drained, many linear or punctate shadows can be seen.
4 Insects can also cause convulsions in the intestines, motility and disorder, leading to intestinal torsion, and even to strangulation and necrosis.
5 Insects in the ileocecal valve, due to ileocecal valve spasm, aphids difficult to pass, clinical manifestations of severe pain, X-ray visible bundles of aphids are embedded in the ileocecal valve.
6 such as intestinal necrosis, can be seen in the surrounding pneumoperitoneum or abscess air cavity.
4.B-ultrasound sound image display:
1 above the obstruction of the intestine dilatation, lumen widening, intracavitary fluid, gas volume, multiple fluid-filled dilated bowel formation polycystic-like performance, fluid flow in the intestinal tract, reflux active, severe obstruction in the intestinal gap with liquid Exudation.
2 Aphid images can be seen in the intestine. A single aphid has a strong echo in the strip. It can be seen that it is active in the lumen. Many aphids often aggregate into a mass. The diagnosis of intestinal obstruction by B-ultrasound can be identified by different sound and shadow. X-ray inspection complements the effect more ideally.
Diagnosis
Diagnosis and identification of aphid intestinal obstruction
Diagnostic criteria
1. Children with medical history often have a history of mites infection, such as history of anal worms or history of vomiting.
2. Clinical manifestations of paroxysmal abdominal pain and vomiting in the umbilical cord, physical bloating is not obvious, and there is no obvious muscle tension, but the abdomen may be in the umbilical cord or the right lower quadrant and a cord-like mass, the mass may be deformed, Move, the surface has high or low unevenness or sensation; the bowel sounds can be normal or hyperthyroidism, and there may be symptoms and signs of complete intestinal obstruction in the advanced stage.
3. Auxiliary examination of the abdominal X-ray film can be seen in the intestinal cavity into a group of insect shadows, so the diagnosis is not difficult.
Differential diagnosis
The disease needs to be identified with intussusception.
