input loop syndrome
Introduction
Introduction to sputum syndrome AfferentLoopSyndrome refers to the Billroth II gastrectomy. After the colonic anastomosis, the bile or pancreatic juice stagnates due to obstruction of the input fistula. There are two types of acute and chronic obstruction. The former is mostly complete obstruction, the latter is reversible and partially obstructed. The patient usually presents with a strangulated high jejunal obstruction, often about 1 hour after a meal, and sudden jet vomiting of bile fluid basic knowledge Sickness ratio: 10%-15% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute pancreatitis peritonitis shock
Cause
Enter the cause of sputum syndrome
Acute input sputum obstruction: often occurs within 24 hours after surgery, but can also occur several days or even years after surgery, obstruction can be partial or complete, intermittent or permanent, after Billroth II, about 1% The patient had an obstruction near the stomach and jejunum at the input sputum. The pre-colon anastomosis was more common than the posterior colon. When the anterior colon was anastomosed, the gap between the fascial membrane and the transverse mesentery was output through the jejunum due to excessive input sputum. When the output is behind the output, strangulated obstruction occurs; if the gastric jejunal anastomosis or the duodenal jejunum is in an intersecting position, the input sputum is present, and the output sputum is in front, such as the latter membrane into the sacral intestine, resulting in Enter the closed obstruction of the jejunum, the posterior colonic anastomosis, the input sputum can be retracted to the transverse mesenteric hole, and obstruction occurs.
As the pancreatic juice and bile outflow are blocked, the pancreatic juice and bile accumulate, causing acute dilatation of the input sputum and causing severe upper abdominal pain, and radiating to the sputum area, frequent vomiting but not much, vomit does not contain Bile, vomiting symptoms can not be alleviated, the upper abdomen has obvious tenderness, sometimes can touch the dilated input sputum, due to excessive effusion in the sputum, causing intestinal fluid to flow back into the pancreatic duct, prone to acute pancreatitis, serum amylase When it is elevated and completely obstructed, the dilated input fistula can be necrotic, perforated, causing peritonitis and shock.
Chronic output obstruction: more than a few weeks after surgery, but also after the next year or more, this type occurs in the Billroth II type of surgery and there are angulation, especially in the pre-colonial anastomosis, the cause The input sputum protrudes into the gap behind the gastric jejunal anastomosis, and a small number of adhesions and jejunum-jejunal intussusception, etc., when the bile and pancreatic juice accumulate in the input sputum to expand, thereby stimulating intestinal peristalsis, so that the product The fluid is discharged into the stomach, causing vomiting of fluids containing bile.
Prevention
Input sputum syndrome prevention
Prevention of this disease: Some scholars have observed that the incidence of large bending in the proximal end is high, so the proximal end can be used for large bending, which is related to the angle of the anastomosis. The anastomosis and the midline of the abdomen in the gastrointestinal anastomosis (parallel line ) Angle 45 °, less than this angle is easy to form an entrance barrier, when the colon is anastomosed to close the mesenteric hole, fixed suture on the stomach wall above the anastomosis, regarding the length of the sputum, some people think that the shorter the better, the shorter the easy to become an angle The length of the colon is not less than 15cm, and the length of the jejunum after the anastomosis is not more than 12cm. The length of the jejunum after the anastomosis is to overcome the tension of the stomach.
Complication
Enter sputum syndrome complications Complications acute pancreatitis peritonitis shock
Can be complicated by acute pancreatitis, peritonitis, shock.
Symptom
Enter the symptoms of sputum syndrome Common symptoms Abdominal upper abdominal pain Abdominal tenderness nausea
The patient usually presents with a strangulated high jejunum obstruction. It often occurs about 1 hour after a meal. Sudden vomiting of bile fluid occurs. Before vomiting, there is often nausea, upper abdominal pain, and radiation to the back. Symptoms are relieved after vomiting. Until the next meal, the upper abdomen has tenderness, and the upper right side of the upper abdomen can sometimes touch the dilated input sputum.
Examine
Enter the examination of hernia syndrome
Possible examinations: simple filming of the abdomen, contrast agent, CT, B-ultrasound.
Diagnosis
Diagnosis and diagnosis of input syndrome
Billroth II gastrectomy, combined with clinical manifestations after pre-colon anastomosis, and Dahlgren, Jordan and other tests can make a diagnosis.
Identification with intestinal obstruction, intestinal adhesion, gastric jejunal input syndrome.
