Congenital gastric outlet obstruction
Introduction
Introduction to congenital gastric outlet obstruction Congenital gastric outlet obstruction refers to pyloric sinus or pyloric obstruction. The incidence rate is 1% of congenital gastrointestinal atresia. It can be divided into 4 types: pyloric sinus occlusion (1%), pyloric occlusion ( 27%), pyloric membrane atresia or stenosis (67%), pyloric sinus membrane atresia or stenosis (5%). basic knowledge The proportion of illness: 0.002% Susceptible people: infants and young children Mode of infection: non-infectious Complications: dehydration, metabolic alkalosis, anemia
Cause
Causes of congenital gastric outlet obstruction
(1) Causes of the disease
It is still unclear. It is speculated that the embryonic tube development is interrupted 8 weeks before the embryo, leading to rupture atresia. After 8 weeks, the endoderm is connected to form a septum after too long connection. It is also considered to be related to the abnormalization of the digestive tract cavitation process. The cause of the disease is similar to that of the small intestine atresia and stenosis, and is in the embryonic stage.
In the process of foregut development, it is caused by luminal malformation. Some people think that there may be vascular malformation, and gastric insults cause atresia and stenosis. In recent years, some people have passed fetal biopsy to report that the fetus has bullous epidermolysis in the uterus. It may cause the pyloric mucosa to form scars and cause pyloric atresia and stenosis. 81 cases were collected, and there were familial pyloric atresia, which is considered to be autosomal recessive hereditary disease. Among the 4 types, the most common pyloric membrane atresia or stenosis. It is also called the gastric diaphragm together with the pyloric sinus membrane occlusion or stenosis. This section focuses on the disease.
(two) pathogenesis
The diaphragm in the stomach is mostly located 1.5 to 3 cm in front of the pylorus, or close to the pylorus. There are also 2 diaphragms in the same place, and the other is located a few centimeters from the pylorus. In the duodenum, the stomach and the duodenum are separated. There are holes (narrow) or no holes (locking), thick 2 ~ 3mm, composed of mucosa, submucosal tissue and muscle layer, both sides are covered with mucous membrane, the gap is filled with loose connective tissue.
Prevention
Congenital gastric outlet obstruction prevention
The current cause of the disease is not yet clear, and it is considered to be an autosomal recessive genetic disease. Genetic counseling should be done.
Complication
Congenital gastric outlet obstruction complications Complications dehydration metabolic alkalosis anemia
Can be complicated by nutritional disorders, growth and development disorders, dehydration, alkalosis, can be complicated by anemia.
Symptom
Congenital gastric outlet obstruction symptoms common symptoms dehydration inflammation pyloric narrow appetite loss edema weight loss
The disease is more common in premature babies, most of the children have a history of polyhydramnios, large diaphragm pores, enough to pass the food, can be asymptomatic, small diaphragm or secondary inflammation caused by mucosal edema to narrow the hole, it can cause obstruction symptoms, health Vomiting soon after, vomiting after feeding, spray, containing milk and milk clots, no bile and blood, vomiting is often intermittent, accompanied by loss of appetite, weight loss, generally less than the standard weight of 10% ~ 15%, some even lower 25% to 40%, crying after eating, irritability, relief after vomiting, vomiting stubborn can occur dehydration, alkalosis, malnutrition, physical examination of the upper abdominal bulging, may have stomach shape, have stomach Peristaltic wave, flat in the lower abdomen, and high-obstruction symptoms when the diaphragm is non-porous (completely locked), such as two diaphragms, the upper part of the isolated stomach and the upper part of the duodenum swell, filled with secretions, forming a sac Sexual mass, accessible in the upper abdomen.
Progressive jet vomiting occurs after the sick child is born, the spit is the stomach content; or intermittent vomiting occurs in infants and young children, gradually losing weight, weight loss, upper abdominal distension, gastric and peristaltic waves, but not touching the mass Should be suspected of pyloric atresia or stenosis, early X-ray examination, is important for the diagnosis of this disease, and can be associated with pyloric fistula, congenital hypertrophic pyloric stenosis, gastric mucosal prolapse, duodenal atresia or stenosis, etc. Identification.
X-ray abdominal standing flat film, only shows a broad liquid level in the left upper abdomen, no gas in other parts of the abdomen, more support for the diagnosis of pyloric atresia, but to distinguish from duodenal atresia, the stomach gastrointestinal fluoroscopy shows that the stomach has different degrees Expansion, expectorant retention, expectorant discharge, patience and careful observation, can be found in the typical characteristics of the valve: a small amount of expectorant into the pylorus or duodenal bulb, pyloric funnel-shaped narrow thin, but not extended without bending Or a thin diaphragm protrudes into the antrum from the longitudinal axis of the pylorus at a distance of 1 to 2 cm from the proximal end of the pylorus; the valve thickness of the elderly is 2 to 4 mm, and the mobility is small, so that the distal end of the stenosis is separated from the proximal end of the pylorus. "Double ball sign."
Fiberoptic gastroscopy shows that there is crescent-shaped mucosal folds at the distal end of the antrum. Sometimes there are small holes in the center, which can not enter the mirror tip. Sometimes the pylorus can be seen through the hole. The fiber endoscope can not only diagnose the disease, but also remove the diaphragm. To treat the disease.
Examine
Examination of congenital gastric outlet obstruction
Blood tests have a decrease in plasma protein and a decrease in hemoglobin, often with alkalosis; blood sodium, potassium, chloride, calcium and blood pH should be checked.
X-ray examination showed gastric bubbles, no inflated shadow in the middle and lower abdomen, normal stomach size, stenosis 1 to 2 cm in front of the pylorus, normal pyloric sphincter and duodenal bulbus through the diaphragm hole, complete closure of the gastric septum Upper digestive tract barium meal, gastroscopic diagnosis, sputum examination, sinus sinus is blind end, and barium enema shows small colon.
Diagnosis
Diagnosis and diagnosis of congenital gastric outlet obstruction
Diagnosis mainly relies on X-ray, upper gastrointestinal barium meal angiography, gastroscopy or surgery to confirm the diagnosis, the diagnosis is unknown, and there are stubborn vomiting and upper abdominal expansion requiring surgical exploration to confirm the diagnosis.
1. Perforation caused by gastric perforation, mechanical damage, intestinal obstruction, etc. caused by other causes in the neonatal period.
2. Meconium peritonitis: children often have no meconium, or less meconium discharge, X-ray shows intestinal adhesion, intestinal lumen inflation, multiple fluid level, intra-abdominal, less free gas under the armpit, stomach bubble Normal, sometimes calcification is visible.
