Internal hernia after biliary drainage
Introduction
Introduction to internal hemorrhoids after intra-biliary drainage After the common bile duct drainage or gastrointestinal tract is used for catheterization, the body anatomy changes, an abnormal gap is formed in the upper, lower or the rupture of the transverse mesenteric membrane, and the intestinal tract is drilled into the gap between the drainage tube and the lateral abdominal wall. It is formed after internal biliary drainage. The clinical manifestations of the symptoms and signs of acute mechanical small bowel obstruction require early surgical treatment. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: toxic shock syndrome
Cause
Causes of internal hemorrhoids after biliary drainage
What is the cause of internal hemorrhoids after biliary drainage?
(1) Causes of the disease
1. Abnormal gap formation
The main anatomical basis for the formation of internal hemorrhoids after biliary drainage is the change of postoperative anatomy, forming an abnormal gap. When performing intra-biliary drainage surgery, a stenosis should be made on the transverse mesorectum to pass the distal free jejunum. The opening is anastomosed to the biliary tract, and two abnormal gaps are formed on the upper and lower sides of the transverse colon (memory). The upper gap is blocked by the omentum and the mesentery, and the obstruction of the omentum is rarely caused, and because it is relatively large Even if the intestine is invaded, the incarceration rarely occurs, and the lower gap is small. Once the small intestine is invaded, the incarceration is easy to occur.
2. Transverse mesenteric tear formation
After the hollow intestine fistula passes through the transverse mesenteric opening, if it is forgotten to fix and fix, or the suture needle is too wide, or the suture is not firmly fixed with the intestinal wall passing through the opening of the transverse mesenteric opening, it can be formed. Abnormal clefts become the pathological basis for the formation of internal hemorrhoids after drainage in the biliary tract. The intestinal fistula can be invaded by the fissures.
3. Intestinal dysfunction, increased intra-abdominal pressure
Postoperative dietary recovery, quality and quantity changes can cause bowel hyperactivity or intestinal dysfunction. In case of increased intra-abdominal pressure (such as severe abdominal distension), changes in body position and other factors, it is easy to promote the intestinal tube from the transverse mesenteric rupture or under the An intrusion occurs when the gap breaks in.
(two) pathogenesis
After intestinal obstruction, a series of complex pathophysiological changes will occur in the local and systemic parts of the intestine. The local changes caused by chronic incomplete intestinal obstruction are mainly the obstruction of the proximal intestinal wall hypertrophy and intestinal lumen expansion, and the distal intestinal atrophy becomes thinner; Systemic changes are malnutrition and water, electrolyte imbalance, acute intestinal obstruction can cause the following changes:
Intestinal expansion
Intestinal swelling is caused by fluid and gas accumulation in the intestinal lumen. The effusion mainly comes from the digestive tract secretion. The normal human digestive tract is 8-10L in the secretion of 24h. After the obstruction, the liquid can not be completely absorbed. The intestinal swell can stimulate the intestine. Increased mucosal secretion and decreased absorption, resulting in severe expansion of the intestine, 70% of the gas in the intestine is a gas that is swallowed, so the gas in the gastrointestinal tract can be absorbed through the gastric tube in the clinic, which can reduce the swelling of the gastrointestinal tract; another 30% The gas is produced by the decomposition of bacteria such as sugars that are diffused into the intestine and in the intestines.
2. Water, electrolyte metabolism disorders and acid-base balance disorders
Loss of body fluids and the resulting imbalance of water, electrolytes and acid-base balance are important pathophysiological changes in intestinal obstruction. Patients with intestinal obstruction are unable to eat and vomit frequently, resulting in a large loss of water and electrolytes in the body, especially in high intestinal obstruction. Low potassium and low chloride metabolic alkalosis due to loss of a large amount of gastric juice, low intestinal obstruction, although vomiting is less, but the digestive juice accumulated in the swollen intestinal tube, sometimes up to 5 ~ 10L; due to dehydration, starvation, loss of potassium, Sodium ions, increased acidic metabolites under hypoxic metabolism, and H+ and reabsorption of NaHCO3 in the kidneys can cause metabolic acidosis and isotonic dehydration.
3. Infection and toxemia
The toxins in the intestinal tract are significantly increased above the obstruction. At the same time, due to the blood vessel disorder or loss of vitality in the intestinal wall, the bacteria multiply and produce a large amount of toxins. The bacteria and toxins penetrate into the abdominal cavity and cause severe peritonitis and toxemia.
4. Shock
Severe water shortage, blood concentration, blood volume reduction, electrolyte imbalance, acid-base balance disorder, bacterial infection, toxemia, etc. can cause severe shock. When intestinal necrosis occurs, peritonitis occurs after perforation, toxic shock is more obvious.
Prevention
Prevention of internal hemorrhoids after intra-biliary drainage
After biliary anastomosis should be routinely sutured, the transverse mesenteric space is closed, which can prevent the small intestine from entering the hole after operation and prevent the occurrence of internal hemorrhoids after biliary drainage.
Complication
Complications of internal hemorrhoids after biliary drainage Complications toxic shock syndrome
Intestinal tube strangulation and necrosis are the main complications of internal hemorrhoids after biliary drainage. At this time, abdominal symptoms are aggravated, and systemic poisoning symptoms may occur. In severe cases, toxic shock may occur.
Symptom
Symptoms of internal hemorrhoids after drainage in the biliary tract. Common symptoms. Intestinal qi spirometry, abdominal pain, reflex vomiting, abdominal distension, peritoneal irritation
The internal hemorrhoids after biliary drainage were more recent than the postoperative, and the clinical manifestations were the clinical manifestations of typical acute mechanical small bowel obstruction.
Symptom
(1) Abdominal pain: manifested as paroxysmal cramps, lasting for a few seconds or minutes, accompanied by bowel sounds during pain, high-pitched bowel sounds, sometimes audible gas, if the pain interval is shortened As a result of severe persistent abdominal pain, bowel narrowing may be considered.
(2) Vomiting: early is reflex vomiting, spit is food or gastric juice, eating or drinking can cause vomiting; late vomit is intestinal content.
(3) Abdominal distension: When strangulation occurs, the abdomen expands asymmetrically and can reach the enlarged intestinal fistula.
(4) Exhaust defecation stopped: After the complete intestinal obstruction occurs, the patient no longer exhausts the bowel movement.
2. Physical examination
Early patients may have different degrees of abdominal distension, showing intestinal or peristaltic waves; touching the abdomen is soft, can swollen and swollen intestinal fistula, with mild tenderness; when there are more gas and liquid in the intestinal fistula, it can smell and vibrate. When the intestine is strangulated, the body temperature rises and the heart rate increases. The abdomen may have localized tenderness and peritoneal irritation. Sometimes it can touch the narrowed intestinal fistula. When the colic is heard, the sound of gas over water and high-pitched metal sound can be heard.
Examine
Examination of internal hemorrhoids after biliary drainage
1. Hemoglobin and hematocrit: increased due to dehydration and blood concentration.
2. Leukocyte liters and classification liters: Intestinal strangulation is considered when the elevation is significantly increased.
3. Serum electrolytes (K, Na, Cl-): reflect the disorder of the electrolyte in the body.
4. Blood gas analysis: reflecting the imbalance of acid and alkali in the body.
5. Vomit and stool examination: There are a lot of red blood cells or occult blood positive, considering the intestinal tube has blood circulation disorders.
4 to 6 days after the occurrence of intestinal obstruction, X-ray examination showed gas in the intestinal lumen, standing or lateral position filming, showing most of the liquid level and bloating intestinal fistula.
Diagnosis
Diagnosis and diagnosis of internal hemorrhoids after biliary drainage
As with other intra-abdominal hernias, this disease is difficult to diagnose before surgery. It is often diagnosed by postoperative acute intestinal obstruction. If mechanical intestinal obstruction occurs recently after biliary drainage, it should be highly alert to the possibility of sputum formation. .
It is necessary to distinguish between postoperative intestinal obstruction and acute pancreatitis after biliary tract infection caused by other causes.
