intragastric diaphragm
Introduction
Introduction to the stomach diaphragm The intragastric septum is clinically rare. The mucosal diaphragm occurs in the antrum or pylorus and travels around the stomach wall, narrowing the end of the antrum, but not locking the stomach cavity. The membrane is a squamous epithelium or a columnar epithelium. Due to congenital dysplasia, the early digestive tract cavitation process is abnormal. The diaphragm is located 1.5 to 3 cm in front of the pylorus, or close to the pylorus, and sometimes two at the same time. The other is located a few centimeters from the pylorus in the duodenum, separating the stomach from the duodenum. basic knowledge The proportion of illness: 0.0002%-0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: edema
Cause
Intragastric diaphragm cause
(1) Causes of the disease
Due to congenital abnormalities, the early digestive tract cavitation process is abnormal, the diaphragm is mostly located 1.5 to 3 cm in front of the pylorus, or close to the pylorus, sometimes two at the same time, and the other is a few centimeters away from the pylorus. Intestine, the stomach and the duodenum are separated, and there are many holes in the center of the diaphragm. The diameter of the hole is 3 to 10 cm. If there is no hole, the internal obstruction and atresia of the stomach are caused. The thickness of the diaphragm is 2 to 3 mm, and the mucosa and the submucosa are The tissue and muscle layer are composed, and the diaphragm is covered with mucous membrane on both sides. The gap is filled with loose connective tissue, and the hole is located at the center or slightly biased. Although there is no muscle fiber, it remains in an expanded state.
(two) pathogenesis
The diaphragm is located 1.5 to 3 cm in front of the pylorus or close to the pylorus. There may also be two diaphragms. The other is several centimeters at the distal end of the pylorus. The diaphragm often has a hole with a diameter of 1 to 3 cm and a diaphragm thickness of 2 to 3 mm. , submucosa and muscle layer composition, such as no hole, gastric obstruction and atresia.
Prevention
Intragastric septum prevention
Pregnant women with excessive amniotic fluid should be alert to the possibility of congenital malformation, amniocentesis and amniotic fluid alpha-fetoprotein, acetylcholinesterase increased at the same time to help prenatal diagnosis.
Complication
Gastric diaphragm complications Complications edema
When the diaphragm hole is large, the food can pass smoothly without symptoms. For example, if the diaphragm hole is small or secondary inflammation causes mucosal edema, the diaphragm hole is narrowed, causing obstruction, mainly manifested as intermittent non-biliary vomiting. Peristaltic waves, such as non-porous diaphragms, have high-level obstruction symptoms and no meconium discharge.
Symptom
Gastric diaphragm symptoms Common symptoms Nausea and vomiting Loss of appetite, abdominal distension, abdominal pain, weight loss
The diaphragm hole is large enough to pass through the food, can be asymptomatic, the diaphragm hole is small or the secondary inflammation causes mucosal edema to narrow the hole, which can cause obstruction symptoms. The most common symptom is vomiting, which occurs soon after birth. Sputum after eating, spray content contains milk and milk clots, no bile and blood, may have abdominal fullness or abdominal pain, characterized by pain after milking, relief after vomiting, vomiting is often intermittent, can be relieved longer Period, may also be accompanied by loss of appetite, weight loss and other symptoms, physical examination of the upper abdomen bulging, gastric peristaltic wave, flat in the lower abdomen, the diaphragm is non-porous, the early high-obstruction symptoms, no meconium discharge as two diaphragm The isolated lower part of the stomach and the upper part of the duodenum are inflated, full of accumulated secretions, forming a cystic mass that is accessible in the upper abdomen.
Examine
Intragastric septum examination
X-ray examination showed gastric sinus, no air shadow in the lower abdomen, normal stomach size, stenosis defects in the 1-2 cm in front of the pylorus, tincture can pass through the diaphragm hole, normal sphincter and duodenal ampulla appeared, intragastric septum Complete atresia can be diagnosed by upper gastrointestinal sputum angiography or gastroscopy.
Diagnosis
Diagnostic differentiation of gastric septum
X-ray examination showed gastric sinus, no air shadow in the lower abdomen, normal stomach size, stenosis defects in the 1-2 cm in front of the pylorus, tincture can pass through the diaphragm hole, normal sphincter and duodenal ampulla appeared, intragastric septum Complete atresia can be diagnosed by upper gastrointestinal sputum sputum angiography or gastroscopy, but often due to refractory vomiting and upper abdominal distension, surgery is not diagnosed after laparotomy.
