Congenital absence, atresia and stricture of duodenum
Introduction
Introduction to congenital absence, atresia and stenosis of the duodenum Congenital absence, atresia and stenosis of the duodenum means that the duodenum is in the process of embryo development, forming a duodenal atresia or stenosis, the incidence rate is about 1/7,000 of the born baby. ~10,000, more common in low birth weight infants, the ratio of atresia to stenosis is about 3:2, accounting for 37 to 49% of all small intestine atresia. The incidence of combined malformations is higher. Clinical manifestations of nausea and vomiting, abdominal pain, gastroesophageal reflux disease, and hiccups. basic knowledge The proportion of illness: 0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: dehydration malnutrition
Cause
Congenital absence of duodenum, atresia and stenosis
Diaphragm type (30%):
The shape of the intestine remains continuous, and there is an unbroken membrane in the intestinal lumen, which is usually single or multiple at the same time; or the diaphragm is a membranous ridge, which is prolapsed to the distal end of the obstruction to form a wind pocket; or There is a needle-like hole in the center of the diaphragm. The food passes through the difficulty. The ampulla is often located on the posterior medial or near and distal side of the diaphragm.
Blind segment type (30%):
The continuous interruption of the intestine, the two blind ends are completely separated, or only the fiber cord is connected, and the mesentery also has a wedge-shaped defect, which is rare in clinical practice.
Duodenal stenosis (30%):
There is a ring hyperplasia in the intestinal mucosa, where the intestinal tube has no expansion function; there is also a narrow section near the ampulla.
The duodenum and stomach of the proximal obstruction are obviously dilated, the muscle layer is hypertrophy, the interventricular plexus is degenerated, the peristaltic function is poor, the distal bowel is small, the intestinal wall is thin, the intestinal lumen is free of gas, and the intestine is narrow. Air is present in the distal intestinal lumen.
Prevention
Congenital absence of duodenum, prevention of atresia and stenosis
There is no particularly effective preventive measure for this disease. Early detection and early treatment are the key to the prevention and treatment of this disease.
Complication
Congenital absence, duodenal and stenosis complications of the duodenum Complications dehydration malnutrition
Due to severe vomiting, there are obvious dehydration, acid-base imbalance and electrolyte imbalance, weight loss and malnutrition and other complications.
Symptom
Congenital absence of duodenum, atresia and stenosis common symptoms intestinal atresia and stenosis
When there is duodenal atresia, pregnant women may have viral infections in the early pregnancy, vaginal bleeding and other phenomena, often with excessive amniotic fluid, frequent vomiting occurs in the baby a few hours after birth, the amount is high, containing bile, such as obstruction in the ampulla The proximal end does not contain bile, there is no normal meconium discharge, or a small amount of white mucus or putty can be discharged, but there may be 1 or 2 times of small gray-green feces. The symptoms are similar to atresia and the degree of stenosis is high. Intermittent vomiting can occur several weeks or months after birth, even after a few years, because of high obstruction, generally no abdominal distension, or only mild upper abdominal distension, gastric peristalsis is rare, due to severe vomiting , there are obvious dehydration, acid-base imbalance and electrolyte imbalance, weight loss and malnutrition.
Examine
Examination of congenital absence, atresia and stenosis of the duodenum
It can be used for X-ray anterior and posterior flat examination. It can be seen that there is a wide liquid level in the left upper abdomen and a liquid level in the right upper abdomen. This is the dilated stomach and the proximal part of the duodenum. There is no gas in other parts of the whole abdomen, forming a double "Bubble sign", which is a typical X-ray sign of duodenal atresia, the plain film of duodenal stenosis is similar to atresia, but the proximal end of the duodenum is slightly dilated, the fluid level is slightly smaller, and a small amount of gas is visible in the remaining abdomen. In neonatal intestinal obstruction, contraindications for barium meal examination can cause fatal sputum aspiration pneumonia, sometimes for the purpose of distinguishing from poor intestinal rotation, can be used as a barium enema to observe the location of the cecum and ascending colon, but it is not Necessary, the diagnosis can be confirmed because of the abdominal plain film.
Diagnosis
Diagnosis and identification of congenital absence, atresia and stenosis of duodenum
diagnosis
It can be used for X-ray anterior and posterior flat examination. It can be seen that there is a wide liquid level in the left upper abdomen and a liquid level in the right upper abdomen. This is the dilated stomach and the proximal part of the duodenum. There is no gas in other parts of the whole abdomen, forming a double "Bubble sign", which is a typical X-ray sign of duodenal atresia, the plain film of duodenal stenosis is similar to atresia, but the proximal end of the duodenum is slightly dilated, the fluid level is slightly smaller, and a small amount of gas is visible in the remaining abdomen. In neonatal intestinal obstruction, contraindications for barium meal examination can cause fatal sputum aspiration pneumonia, sometimes for the purpose of distinguishing from poor intestinal rotation, can be used as a barium enema to observe the location of the cecum and ascending colon, but it is not Necessary, because the abdominal plain film can be seen, the diagnosis can be confirmed. The history of elderly children is not typical. If there is partial obstruction of the duodenum, it can be used for swallowing examination. After the examination, the expectorant should be sucked out.
In recent years, there are two liquid masses in the abdominal cavity measured by prenatal ultrasound tomography, which has certain value for diagnosis and can provide a basis for early postoperative surgery.
Differential diagnosis
It is mainly differentiated from other diseases that cause vomiting, such as intestinal obstruction and intussusception.
