Congenital stricture of duodenum
Introduction
Introduction to congenital stenosis of the duodenum Congenital stenosis (congenitalstenosis of duodenum), similar to duodenal atresia, is only mild in the embryonic period, only stays in the stenosis stage, so the prognosis is good, the incidence is also low. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: malnutrition, anemia
Cause
Causes of congenital stenosis of the duodenum
Cavity insufficiency during embryonic development (30%):
Normal intestinal development through the lumen opening, epithelial cell proliferation and re-cavation three stages, when the embryonic intestines develop obstacles in the second or third month, the occurrence of vacuoles but incomplete fusion, the formation of intestinal stenosis.
Intestinal blood circulation disorder during fetal period (25%):
For example, when the embryo is inserted into the abdominal cavity from the umbilical sac for 10 to 12 weeks, the umbilical ring is contracted prematurely, resulting in poor blood circulation in the small intestine; small intestinal nutrient vascular development defects or branch malformations can also cause intestinal malformation and develop into intestinal stenosis. .
Pathogenesis:
The most common stenosis is the lower part of the duodenum. The degree of stenosis of the intestine is different. The intestine does not lose its coherence. There is a ring in the mucosa of the duodenum, and the intestinal cavity is lightly blocked. There is no expansion function, the disease course develops slowly, the proximal intestine segment forms a huge duodenum, some are diaphragm type, and there is a large pore in the center; some duodenal stenosis is in the vicinity of the common bile duct pancreatic ampulla. Narrow section.
Microscopic examination of the tissue section showed that the narrow band was composed of mucosal and fibrous submucosal tissue, and the proximal intestine was dilated but did not cause ischemia, necrosis and perforation.
Prevention
Duodenal congenital stenosis prevention
1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.
Complication
Duodenal congenital stenosis complications Complications, malnutrition anemia
Due to repeated vomiting, children may develop water, electrolyte imbalance, longer course, sick children may develop malnutrition, manifested as weight loss or anemia.
Symptom
Symptoms of congenital stenosis of the duodenum Common symptoms Intestinal atresia, stenosis, bloating, nausea and vomiting constipation
Compared with duodenal atresia, patients with duodenal stenosis are relatively old, mostly children of several months or even a few years old. Symptoms occur later than atresia, and often occur intermittently. Clinical vomiting is the main symptom. More than 4 days to 1 month after birth, only vomiting 1 or 2 times a day, but also for several weeks, not vomiting for several months, because most of the stenosis is located in the third and fourth part of the duodenum, so there is more vomit Contains bile, rarely contains blood, the frequency and nature of stool can be normal. When vomiting is severe, moderate or severe constipation may occur, and the upper abdominal distension may vary from light to heavy.
Examine
Examination of congenital stenosis of the duodenum
According to the condition, blood, urine, routine, biochemical and electrolyte tests can be selected.
X-ray barium meal imaging, imaging features of duodenal stenosis are:
1 duodenal centripetal stenosis, and shows the length and extent of the stenosis;
2 sometimes visible signs of duodenal membrane;
3 When the stenosis is obvious, it can show the extreme expansion of the proximal side of the duodenum, which is like giant duodenal disease;
4 The stomach and duodenum can be enlarged while having a stomach sag, sometimes up to the sputum.
Diagnosis
Diagnosis and differentiation of congenital stenosis of duodenum
diagnosis
The child has a history of intermittent vomiting since childhood, swelling of the upper abdomen, sound of water, etc. X-ray barium meal sees duodenal stenosis, and the first and second segments of the stomach and duodenum are extremely enlarged. diagnosis.
Differential diagnosis
Duodenal stenosis should be differentiated from congenital hypertrophic pyloric stenosis and duodenal atresia.
Duodenal stenosis should also be associated with a ring-shaped pancreas, a vagus peritoneal band twist, a duodenal kinks, a displaced or rotated external cecal compression, a vagus superior mesenteric artery or a duodenal anterior portal vein. Identification of intestinal obstruction, barium meal examination, barium enema and abdominal B-ultrasound examination are helpful for differential diagnosis, but the identification of the cause is difficult, and it is often necessary to confirm the diagnosis.
