double stomach
Introduction
Introduction of double stomach Double stomach (doublestomach), also known as gastric repetitive malformation, is extremely rare in clinical practice, accounting for about 9% of the entire digestive tract malformation. According to available data, the disease is more common in children and adolescents, with slightly more women than men. basic knowledge The proportion of the disease: the probability of the population is 0.09% Susceptible people: no special people Mode of infection: non-infectious Complications: blood in the stool, abdominal pain
Cause
Double stomach cause
(1) Causes of the disease
The cause is not known and may be related to the following factors.
1. The theory of vacuolization
At 6 weeks, the growth of the digestive tract is faster than that of the whole embryo. The rapid growth of the length of the digestive tract depends on the proliferation of the intraluminal epithelial cells, causing the stenosis or occlusion of certain parts of the lumen to become solid cord-like bodies. In the case, the liquid secreted by the epithelial cells accumulates between the cells to form vacuoles, which are arranged longitudinally along the digestive tract, then fuse with each other or with the main lumen, and when all epithelial cells are pulled apart to cover the growing digestive At the surface of the channel, all the vacuoles are finally completely placed in the cavity to complete the growth of the digestive tract. If a group of cells fuses with each other but does not communicate with the digestive tract during the vacuolarization, a cystic deformity is formed, and the stomach is also empty. Incomplete foaming.
2. Adhesion of ectodermal and endoderm
McLetchie suggested that the occurrence of digestive tract malformation is related to developmental disorders at 3 weeks of embryonic development, and abnormal adhesion between endoderm and ectoderm. At that time, it was the stage of formation of the notochord, which first split into two segments, through the pores between the two segments, inside, Adhesion occurs in the ectoderm, so that the spinal cord and the vertebral body pass through the spinal cord and the vertebral body to form a nerve-intestinal tube. In the later development process, the nerve-intestinal tube forms various kinds by differentiation or complete retention or residual part. Repeated deformity.
(two) pathogenesis
In the general form, the double stomachs are characterized by cysts of various shapes and sizes, and the small ones are only a few centimeters in diameter, and the larger ones can repeat for the entire stomach, and even extend to the esophagus and duodenum.
Both stomachs occur in the pyloric part of the large curved side of the stomach. Most of them are cystic with the stomach cavity. They have a common wall and a tube with the stomach. The inner mucosa is mostly gastric mucosa, and a few are mucosa adjacent to the digestive tract. There may be ectopic pancreatic tissue around it, sometimes with a duct connected to the ectopic pancreatic duct, and even an ectopic pancreatic duct can be connected to the duct of the double stomach and the normal pancreas, respectively. The cystic double stomach is due to the endocrine secretion. Increasingly, the cysts are enlarged, and incomplete pyloric obstruction occurs in the compression of the stomach. The gastric mucosa of the double stomach secretes gastric acid to produce peptic ulcer.
Prevention
Double stomach 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
Double stomach complications Complications, blood in the stool, abdominal pain
It is even more rare to cause peptic ulcer. If ulcers occur, hematemesis, blood in the stool, upper abdominal pain, and even perforation may occur.
Symptom
Double stomach symptoms Common symptoms Cystic mass Stomach shift Abdominal pain Abdominal pyloric stenosis
Symptoms and signs are not obvious. Most of the symptoms appear in the year after birth. It is related to the size and location of the cyst, whether it is connected with the stomach, and whether there is ectopic mucosa. The main symptoms of 1/3 cases are vomiting and upper abdominal pain. Blood in the stool, constipation, weight loss and other symptoms, the only signs for the upper abdomen can touch the cystic mass, double stomach can also occur high intestinal obstruction, abdominal distension, upper abdominal tenderness, anemia and dehydration and other signs, obstruction than the double small intestine Less, causing peptic ulcer is even more rare, such as ulceration can occur hematemesis, blood in the stool, upper abdominal pain, and even can cause perforation.
Examine
Double stomach examination
1. X-ray barium meal inspection
It shows that the stomach has a curved curvature or a circular mass protruding into the gastric cavity, which causes the pyloric deformation to narrow. A few stomachs that communicate with the stomach cavity can be seen to flow into the double stomach cavity.
2. Abdominal wall B-ultrasound
The cystic mass of the upper abdomen can be found by endoscopic ultrasonography (EUS), which can clearly distinguish the layers of the stomach wall and the cysts attached to the outer layer of the stomach, and even find the inside of the stomach. New creatures.
3. Gastroscopic examination
A cystic mass that protrudes into the antrum or pylorus can be found. In addition, CT and MRI can be performed. For patients with recurrent pancreatitis, whether the ectopic pancreas and the ectopic pancreas are connected to the double stomach The most feasible method of examination is retrograde cholangiopancreatography.
Diagnosis
Double stomach diagnosis
diagnosis
History
After a history of interstitial vomiting, mainly undigested food in the stomach.
2. Clinical manifestations
Upper abdominal cystic mass, anemia, malnutrition, etc.
3. Auxiliary inspection
Gastric barium meal angiography can show a stenosis caused by a large curvature of the stomach or a circular mass protruding into the gastric cavity; endoscopic ultrasound shows the cyst attached to the outer layer of the stomach; gastroscopy can be found in the cystic sinus or pylorus Mass.
Differential diagnosis
Should be differentiated from mesenteric cysts, the latter generally does not occur intestinal obstruction, hematemesis, blood in the stool.
