Esotopic tissue of the esophagus
Introduction
Introduction to esophageal ectopic organization Bergmann (1958) et al first reported such malformations, also known as substantial intratracheal bronchial remnant (Solidintramuraltracheolbronchialrestsintheesophagus) or phylogenes (choristomas). Both the esophagus and the trachea are developed from the embryonic foregut. At the third week of the embryo, the two are a common tubular organ. By the sixth week, during the separation of the trachea and the esophagus, the esophageal wall is entangled with the tracheal cartilage and the esophageal wall. Contains mucous glands, mostly in the lower part of the esophagus. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia
Cause
Etiology of esophageal ectopic tissue
Congenital factors (85%):
Both the esophagus and the trachea are developed from the embryonic foregut. At the third week of the embryo, the two are a common tubular organ. By the sixth week, during the separation of the trachea and the esophagus, the esophageal wall is entangled with the tracheal cartilage and the esophageal wall. Contains mucous glands, mostly in the lower part of the esophagus.
Acquired factors (10%):
Wang Hongxue (1987), Yin Xingjia (1988) reported 1 case and 2 cases of benign stenosis caused by tracheal cartilage labyrinth, and 1 case of male child who had vomiting for 14 months after birth, especially in the past six months, with cough and cyanosis And repeated episodes of aspiration pneumonia, expectorant retention at 3.0cm on the cardia, proximal esophageal dilatation (diameter 5cm), conical stenosis with jagged filling defects, atropine treatment is ineffective, intraoperative esophageal hiatus defect, esophagus and The thoracic aorta is descending from the aortic sac of the diaphragm, the lower part of the esophagus is stiff near the cardia, the esophagus is 1cm above the cardia, the wall thickness is about 0.5cm, and there are 5 semi-annular tracheal cartilage clamped in the esophageal wall. The inner diameter of the esophagus was 2 mm. The pathology confirmed that the congenital esophageal wall caused by benign stenosis in the lower esophagus, the zigzag filling defect and the dynamic observation of atropine were helpful for identification with the sputum.
Other diseases (5%):
Wang Chengbao (1987) reported a case of ectopic bronchial tissue in the lower esophagus. The 2.5-year-old male child often had vomiting milk with cough after 2 months of birth, and the symptoms gradually worsened. The drug treatment was ineffective. X-ray showed the lower esophageal section up to 5.0 cm narrow. , 0.3cm wide, excision of the esophagus in the stenosis, pathological confirmation of ectopic bronchial tissue in the lower esophagus.
Prevention
Esophageal ectopic tissue prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Esophageal ectopic tissue complications Complications pneumonia
Inhaled dyspnea or aspiration pneumonia.
Symptom
Esophageal ectopic tissue symptoms Common symptoms Dysphagia Rat tail esophageal dilatation sputum pendulum sign nausea dyspnea cough
Postlethwait (1979) reported 23 cases, including 13 cases under 2 years old, 7 cases from 3 to 10 years old, and 3 cases of adults.
1. The main manifestations are dysphagia, nausea, and complications such as inhalation dyspnea. The esophagus and trachea are developed from the embryonic foregut. At the third week of the embryo, the two are a common tubular organ. During the separation of trachea and esophagus in 6 weeks, tracheal cartilage was occluded in the esophageal wall, and mucous glands in the esophageal wall were found in the lower esophagus. He Yanru reported 16 cases of benign esophageal stricture caused by obstruction of tracheal cartilage in the esophagus. Among them, 12 cases of stenosis were located in the lower part of the esophagus, 4 cases were located in the middle part, and the stenosis section was about 2 cm long. The proximal esophagus was obviously dilated and the end was suddenly narrowed, which was called "rat tail sign".
2. In a small number of patients with narrow stenosis, a small sac-like sacral area (which is a normal esophagus) is also seen between the stenosis and the sacral sac. It is quite like a pendulum.
Wang Hongxue (1987), Yin Xingjia (1988) reported 1 case and 2 cases of benign stenosis caused by tracheal cartilage labyrinth, and 1 case of male child who had vomiting for 14 months after birth, especially in the past six months, with cough and cyanosis And repeated episodes of aspiration pneumonia, expectorant retention in the 3cm on the cardia, proximal esophageal dilatation (diameter 5cm), conical stenosis with jagged filling defects, atropine treatment is ineffective, intraoperative esophageal hiatus defect, esophagus and chest The aorta is descending from the aortic hole of the diaphragm, the lower part of the esophagus is stiff near the cardia, the esophagus is 1cm on the cardia, the wall thickness is about 0.5cm, and there are 5 semi-annular tracheal cartilage clamped in the esophageal wall, esophagus. The inner diameter of 2mm, the pathology confirmed that the congenital esophageal wall caused by tracheal insufficiency in the lower esophagus, the zigzag filling defect and the dynamic observation of atropine effect, help to identify with the cardia.
Wang Chengbao (1987) reported a case of ectopic bronchial tissue in the lower esophagus. The 2.5-year-old male child often had vomiting milk with cough after 2 months of birth, and the symptoms gradually worsened. The drug treatment was ineffective. X-ray showed the lower esophageal segment up to 5 cm narrow. 0.3cm wide, the esophagus was removed from the stenosis, and the pathologically confirmed ectopic bronchial tissue in the lower esophagus.
This disease is mostly children, is a congenital anomaly, should pay attention to the identification of sputum, Xue Feng (1988) reported 14 cases of esophageal stenosis caused by tracheal and bronchial cartilage, 6 cases were misdiagnosed as sputum, the misdiagnosis rate reached 43% .
Transplanted tissue in the esophagus can also include pancreas and thyroid tissue, but it is very rare.
Examine
Examination of esophageal ectopic tissue
Esophageal swallowing: visible barium in the corresponding part of the esophagus, the proximal esophageal expansion conical stenosis has a jagged filling defect.
Diagnosis
Diagnosis and differentiation of esophageal ectopic tissue
diagnosis
Clinical diagnosis is mainly based on X-ray examination, and the performance is as follows:
1. The stenosis is mostly located in the lower part of the esophagus, above the cardia, and the length is 1~5cm. The thickness of the lumen is uneven and the edge is smooth.
2. The esophagus is dilated above the stenosis, and the expectorant is retained, which is funnel-shaped.
3. The treatment of antispasmodic drugs is ineffective, combined with endoscopy and biopsy histological data to confirm the diagnosis.
Differential diagnosis
1. Congenital esophageal stenosis Congenital esophageal stenosis often has sputum cough, slow sucking, galactorrhea, and esophageal obstruction with age. Children are often accompanied by slow growth, stunting, and younger age. The higher the incidence of aspiration pneumonia.
2. Esophageal fistula and esophageal ring intermittent dysphagia is the main symptom of the lower esophageal ring. When eating in a hurry, the patient has the feeling that the food mass blocks the esophagus and cannot swallow. At this time, the patient tries to flush the food group by spitting or drinking the food. Such methods, in order to alleviate the symptoms, so if it works, the patient will learn from it, in order to avoid the difficulty of swallowing difficulties caused by rushing to eat, but in the process of eating in the future, slowly, for weeks, even months Similar symptoms appear.
