blind loop syndrome
Introduction
Introduction to blind sputum syndrome Blind sputum syndrome refers to the failure of the colonic obstructive lesions to be resected. When the ileum and the colon are in line with the shortcut, due to the reverse peristaltic anastomosis, a part of the intestinal contents enters the intestines of the intestines, causing a series of symptoms caused by the expansion of the intestines. . basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: colitis
Cause
Causes of blind sputum syndrome
Colonic tumors and inflammation cause intestinal stenosis, and the diseased tissue can not be removed due to systemic or local causes. To solve the problem of colonic obstruction, only the shortcut of the ileum and colon can be used to solve the different degrees of intestinal obstruction. When the transverse colon is anastomosed or the sigmoid colon is double-ended, the ileum is not twisted and crossed, and it is directly matched with the colon, resulting in an inverse peristaltic anastomosis. That is, a part of the proximal ileum first enters the colon of the fistula and then enters the distal colon. If not fully obstructed, part of the stenosis enters the proximal colon of the sac, causing a series of pathological changes.
In patients with blind sputum syndrome, a part of the proximal ileal contents enters the distal colon of the sac, causing the colon to squirm, sending most of the contents into the distal colon; and a part of the stenosis enters the temporary Proximal colon, this part of the contents, there are two ways to discharge, one is the peristalsis through the stenosis and then discharged into the distal colon; the second is through the reverse peristalsis from the distal ileum of the fistula into the distal colon.
Prevention
Blindness syndrome prevention
When the ileum shortcut is anastomosed, it must be squirming, consistent with the direction of peristalsis of the large intestine, and at the proximal end of the anastomosis, 2 to 3 needles should be strengthened, and the muscle layer of the sarcoplasmic layer should be sutured to make the direction of peristalsis more consistent, if the ileum is double-ended. The distal end is anastomosed to the proximal end of the colon, and the proximal end of the ileum is anastomosed to the distal end of the colon. The two anastomosis should be about 5 cm apart to prevent reflux.
If the lesion fails to cause complete obstruction of the intestinal lumen, the end of the ileum is closed, and the proximal ileum is anastomosed at the proximal end of the colon lesion. This is a big mistake. Because the lesion develops into a complete obstruction, the gap between the closed mouth and the lesion is Intestinal mucosal secretions increase, gradually expand, can rupture to form peritonitis, the line is a surgical error, should be vigilant.
Complication
Blind syndrome complications Complications colitis
Tumors and inflammation of the colon.
Symptom
Symptoms of blind sputum syndrome Common symptoms Nausea abdominal pain Abdominal pain with nausea, vomiting, bowel bloating
Abdominal pain
Accompanied by nausea and vomiting, symptoms can be produced after recovery of intestinal peristalsis after surgery. The pain can be abdominal pain, dull pain, and severe cramps.
2. Bloating
In the proximal end of the original intestinal obstruction lesion, the corresponding abdominal distension is discomfort, and bowel sounds may also occur.
3. Signs
Mainly for the signs of the original intestinal obstruction lesions, such as tumors, tenderness, followed by intestinal obstruction lesions in the proximal end of the intestinal dilatation of intestinal type and peristaltic waves, and can touch the sausage-like mass and dilated bowel.
Examine
Examination of blind sputum syndrome
X-ray inspection
Abdominal plain film, visible dilated bowel (obstructive lesion proximal tubule), small bowel angiography: shows that the expectorant is retrograde from the anastomosis into the intestine's intestine, and a part of it is retrograde into the proximal intestine through the stenosis, and then Push the sputum into the distal end of the anastomosis or reverse peristalsis to the anastomosis site.
2. B-mode ultrasound
It can detect the lesion of the original colon and the proximally dilated bowel.
Diagnosis
Diagnosis and diagnosis of blind sputum syndrome
Can be diagnosed based on clinical symptoms and laboratory tests.
Differential diagnosis
Adhesive intestinal obstruction
There is a history of ileocecal anastomosis surgery, abdominal pain, abdominal distension, vomiting and cessation of venting, defecation performance, abdominal plain film with small intestinal fluid gas level can be identified.
2. Anastomotic stricture
If there is an anastomotic stenosis between the proximal ileum and the large intestine, abdominal pain, abdominal distension and other symptoms of intestinal obstruction may occur. However, the abdominal plain film has no intestine and no dilatation. The small intestine angiography indicates that the expectorant is difficult to pass through the anastomosis. The difference is not difficult.
