duodenal duplication
Introduction
Introduction to duodenal duplication Duplication of the duodenum (duplication of the duodenum), also known as duodenal cyst, is a spherical cavity that protrudes beyond the intestinal wall. Most stick to the posterior or medial side of the duodenum. It is a clinically rare congenital malformation of the duodenum. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: peritonitis
Cause
Duodenal duplication malformation
(1) Causes of the disease
There are many explanations for the cause of congenital digestive tract duplication, but there is no satisfactory conclusion, no breakthrough progress, and there are generally several theories:
1. Cavitation is incomplete Bremer believes that due to cell proliferation in the early stage of the embryo, the digestive tract becomes a solid phase. Later, in the solid period, the longitudinally arranged vacuoles are formed in the intestinal lumen, which fuse to form a lumen (cavitation period), such as cavitation It can form stenosis, occlusion and other deformities. If in this development process, the vagus lumen forms a circular tubular cavity, which is a repeated deformity, adheres to the wall of the adjacent intestinal tract, and the duodenum repeats the deformed histological structure and twelve. The fingernails are very similar.
2. The sacral outer bag is not degraded. Thyng and Lewis found that human embryos are as early as mammals. Each part of the digestive tract has a sacral outer bag with the most ileum, which is consistent with the fact that repeated deformities occur in the ileum. In case, the diverticular shaped outer bag can gradually degenerate on its own
3. Others such as embryonic doctrine: In 1953, Ravithch believed that the rectal colon repetitive malformation, like the double penis scrotum, double uterus and vagina, the double urethra, is caused by embryonic axillary malformation, the notochord and the original intestine separation disorder theory: 1892 Veencklass considered the embryo At the 3rd week, when the notochord was formed, adhesion occurred in the inner and outer ectoderm, separation was difficult, and the intestinal tube and the neural tube were separated. When the intestinal tube was formed, diverticulum-like protrusions occurred, and the protrusion developed into various forms of digestive tract repeat deformity.
(two) pathogenesis
Duodenal duplication is often located inside the duodenum (Fig. 1). The shape is spherical, oval, and most of them are cystic. Because they are not connected to the intestine, they are also called intestinal cysts.
The intestinal wall of duodenal duplication is similar to the normal duodenal wall. Most of them are cystic. The wall of the duodenum contains a serosal membrane, smooth muscle, mucous membrane, and the mucosa of the wall often has a vagal gastric mucosa, which can also cause ulcers. Disease, upper gastrointestinal bleeding, inflammation perforation, most of the cysts do not traffic, can also be supplied by the same small intestine vasculature, the distal and proximal end of the cyst can communicate with the duodenum, there is colorless mucus in the cyst, sometimes bleeding It is purple-black, and according to the pathological shape, it can be divided into three types: diverticulum type, cyst type, and tube type.
Prevention
Duodenal duplication deformity prevention
No special methods to prevent.
Complication
Duodenal duplication malformation complications Complications peritonitis
The vaginal gastric mucosa secretes a large amount of gastric acid, which can erode the ulcer of the cyst wall and duodenal mucosa, and can also erode the large blood vessels under the mucosa, causing massive bleeding in the digestive tract; perforation of the intestinal wall or the wall of the capsule is accompanied by severe peritonitis.
Symptom
Duodenal Repeat Malformation Symptoms Common Symptoms Anorexia Cyst Abdominal Discomfort Abdominal Tumor Weight Loss
Most of the symptoms occur in babies. Symptoms appear when the first breastfeeds, but they are also found as late as 60 years old.
1. The upper abdominal mass can generally touch an active mass in the upper abdomen. Sometimes, before the symptoms occur, the mass is found, the size is different, mostly round, cystic, and the larger can even be filled with the costal margin. In the gap, there are reports that duodenal duplication can cause cancer.
2. Obstructive symptoms due to cystic deformity enlargement, oppression of the duodenum, causing complete or incomplete obstruction, and occasionally jaundice.
3. Pain The mucous membrane in the deformity secretes a large amount of fluid, and the pressure in the cavity increases, which can cause pain.
4. Intestinal necrosis occasionally causes bleeding and intestinal necrosis due to compression of the duodenum.
5. Ulcer bleeding, perforation is often due to the vaginal gastric mucosa secreted a large amount of gastric acid and digestive enzymes, erosion of the wall or duodenal intestinal wall ulcers, blood in the stool is mostly tar-like.
Examine
Duodenal duplication abnormality examination
1. X-ray barium meal examination shows that the duodenum has enlargement, compression deformation and high intestinal obstruction performance, and sometimes the tumor shadow can be found (Figure 2).
2. Other radionuclide 99mTc scans are helpful for gastrointestinal bleeding, and CT examination can also confirm the diagnosis.
Diagnosis
Diagnosis and identification of duodenal duplication
Duodenal duplication is mostly caused by babies. On weekdays, the stomach is poor, weight loss, occasional upper abdominal discomfort, vomiting, large cysts can press the duodenum, causing incomplete or complete intestinal obstruction, vomit may have Bile, X-ray examination is helpful for diagnosis, can understand the location of the deformity, the degree of intestinal tract, etc., CT examination can also confirm the diagnosis.
Differential diagnosis
1. Common bile duct dilatation The patient's right upper abdomen can be paralyzed and masses, intermittent mild jaundice, abdominal pain, barium meal examination, duodenal contour becomes larger, stomach shifts to the left front, generally does not cause duodenal obstruction, When the duodenum repeat deformity is huge, the clinical can be paralyzed and mass, can directly press the duodenum to cause high duodenal obstruction, nausea and vomiting, with bile, 99mTc scan, CT examination can distinguish the diagnosis.
2. Mesenteric cysts have no muscle layer due to the wall of the capsule and do not communicate with the intestinal lumen; while the intestinal repeat deformity has serosal, muscular, mucosal, and intestinal walls closely connected with the normal duodenum, which is not easy to be separated from the intestinal tract, and is easily damaged by blood vessels. Intestinal necrosis, the content of the mesenteric cyst is lymph, a colorless transparent liquid, or a pale yellow liquid; the duodenal duplication of the cystic cavity is part of the intestinal contents, or orange-yellow, black, or bleeding Infection.
3. Right kidney mass ureteral pelvis junction obstruction can cause hydronephrosis, right nephroblastoma sometimes large volume, substantial, negative light transmission test, and hydronephrosis is cystic, light transmission test is positive, ultrasound examination and CT examination can distinguish the diagnosis, the nephroblastoma clinically has a chronic weight loss face, double-checking the disease side of the waist has a mass bulging backward, IVP can be distinguished.
4. Intussusception in infants with acute intussusception can have 4 major symptoms: vomiting, paroxysmal crying, abdominal mass, blood in the stool, duodenal duplication, slow progression, occasional upper gastrointestinal bleeding, high Obstructive performance, sputum or air enema can be diagnosed differently.
