gastric diaphragm
Introduction
Introduction to gastric diaphragm The congenital gastric diaphragm (stomachdiaphragm) is a rare gastrointestinal malformation with an incidence of about 1/100,000, accounting for about 1% of the digestive tract atresia. Most of the existing information about this disease is reported in a single case. According to statistics, there is no significant difference in the incidence rate between men and women. basic knowledge The proportion of illness: 0.0002%-0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: double stomach
Cause
Gastric diaphragm cause
(1) Causes of the disease
It was previously thought that the occurrence of gastric septum was related to the recanalization of the embryonic primitive gut, namely the Tandler hypothesis, which hypothesized that the epithelium of the digestive tract proliferated after 6 weeks of embryos, occluding the lumen into a solid cord-like body, and then Cavitation occurs in the cord, and then vacuole fusion, lumen recanalization, such as during the development of the pylorus stopped in the solid cord-like phase or the vacuole is incomplete, the formation of the gastric septum, but now some people think There is no Tandler proliferation stage during the development of the stomach, and the formation of the pyloric septum is the result of excessive hyperplasia of the local endoderm tissue.
(two) pathogenesis
According to the different parts, the gastric diaphragm is divided into gastric sinus type and pyloric type.
The gastric septum is generally located 1 to 7 cm above the pylorus. The diaphragm is composed of mucosa and submucosa. The diaphragm is covered with normal mucosa on both sides. The thickness of the diaphragm is 2 to 3 cm. It is soft but tough. The non-porous membrane can cause complete obstruction of the pylorus. a perforated septum located in the center of the septum or on one side, 2 to 3 cm in size, resistant to artificial expansion, found in children and adults.
Prevention
Gastric diaphragm 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
Gastric diaphragm complications Complications
Double stomach.
Symptom
Gastric diaphragm symptoms Common symptoms Eating vomiting, breathing difficulties, runny nose, upper abdominal pain
According to clinical manifestations, it is divided into the following 2 types.
Non-porous diaphragm
Found in neonates, manifested as complete pyloric obstruction, frequent vomiting soon after birth, vomit does not contain bile, often have difficulty breathing, cyanosis and excessive salivation, the child can discharge a small amount of feces after birth, but later No stool discharge, physical examination can be found in the upper abdomen, visible in the stomach, the lower abdomen is flat or hollowed into a boat.
2. Perforated diaphragm
Found in children and adults, according to the size of the diaphragm pore size, the degree of obstruction and the onset of the disease are different, patients often have vomiting after birth, intermittent, vomiting often occurs after eating, vomit is not digested, Except for bile, patients often experience symptoms such as upper abdominal discomfort or upper abdominal pain after eating. The symptoms are often relieved after vomiting. Patients often have poor weight or weight loss due to poor appetite. If the obstruction is not serious, physical examination No special discoveries.
Examine
Gastric diaphragm examination
X-ray examination, the size of the stomach is normal, the stomach is inflated, the dilatation has a liquid level, and it is seen from the barium meal. It can be seen from the stenosis area 1 to 2 cm away from the pylorus. The barium meal is examined, and the stenosis area is 1 to 2 cm away from the pylorus. Then, the normal pylorus and duodenum appear. If there are two diaphragms, the upper part of the duodenum can be seen to expand again.
Diagnosis
Gastric diaphragm diagnosis
The diagnosis of gastric septum is difficult. When the newborn has frequent vomiting of stomach contents without bile, the disease should be considered. The non-porous gastric septum sputum examination can find complete pyloric obstruction, clinical manifestations of the perforated gastric septum and X-ray. It is found that it is difficult to distinguish from congenital hypertrophic pyloric stenosis. Gastroscopic examination is helpful for diagnosis, and X-ray false positive results can be excluded.
The perforated gastric septum should be differentiated from the congenital hypertrophic pyloric stenosis. The former has no features except the abdomen. The X-ray findings have the following characteristics: 1 The pylorus has no "shoulder sign" protruding into the cavity, and it has an arc shape. 2 There is no nipple sign in the lower part of the small stomach, there is no constant "bird's beak" sign in the 3 pylorus, 4 no stenosis in the stomach cavity above the diaphragm, so there is no sign of pyloric tube elongation, 5 no lumps in the pylorus, duodenal bulb There is no umbrella or curved impression.
