pediatric dynamic ileus
Introduction
Introduction to pediatric dynamic intestinal obstruction Dynamic intestinal obstruction is an intestinal obstruction caused by intestinal motility dysfunction caused by abnormal intestinal dysfunction, also known as paralytic ileus or pseudo-intestinal obstruction. The incidence of pediatric children is higher than that of adults. Because mechanical intestinal obstruction and dynamic intestinal obstruction treatment are very different in principle, it is necessary to master the basic characteristics of pediatric dynamic intestinal obstruction in order to get the correct treatment in the early stage. basic knowledge The proportion of illness: 1% Susceptible people: children Mode of infection: non-infectious Complications: dehydration metabolic acidosis
Cause
Causes of pediatric dynamic intestinal obstruction
(1) Causes of the disease
The causes of dynamic intestinal obstruction fall into two categories: secondary and primary.
Secondary
Concurrent with other diseases, children, especially small babies, a variety of severe diseases can cause intestinal paralysis, such as enteritis, sepsis, pneumonia, etc., the mechanism of intestinal paralysis is caused by excessive sympathetic excitation, the role of sympathetic nerves in the intestine In order to inhibit, the intestinal peristalsis disappears after being inhibited. The gas and liquid in the intestinal tract are absorbed or pushed down at any time during normal peristalsis. Therefore, the small intestine usually does not contain gas. After intestinal paralysis occurs, the peristalsis stops and the absorption function is impeded. The gas liquid stays, causing the intestines to swell and further lose power, forming a vicious circle.
2. Primary (idiotype)
There is no obvious cause of intestinal motility abnormality, some sick children appear symptoms after birth, and some symptoms appear at least in the years or adolescence, the symptoms of intestinal obstruction can be sustained or repeated, the diagnosis and treatment are more difficult, the mortality rate is high, if For a certain abnormality of the intestinal tract, the intestine can be removed or placed, and the sick child can be gradually recovered.
(two) pathogenesis
Under normal circumstances, the intestinal contents are pushed down mainly by the movement and contraction of the muscles of the intestinal wall. The movement of the muscles of the intestinal wall depends on the function of the muscles of the intestinal wall on the one hand, and on the other hand, the regulation function of the autonomic nerves on the other hand, in recent years. Come, it has been reported that gastrointestinal hormones have a great influence on intestinal wall movement. Therefore, the cause of dynamic intestinal obstruction should be considered from the intestinal wall itself, autonomic nervous system or gastrointestinal hormones. Pathological changes are divided into three types: intestinal Muscle lesions, intestinal myenteric plexus lesions and non-neuromuscular lesions, after intestinal paralysis, the small intestine colon is inflated, the intestinal wall is thinned, the movement and absorption capacity have been lost, and due to the enlargement of the intestinal fistula, the intestinal wall blood supply is affected. Compression caused by venous congestion or arterial ischemia, fluid leakage in the abdominal cavity, increased intestinal contents and bacterial metabolites, children with toxic reactions, clinical symptoms of complete or partial intestinal obstruction, secondary Sexual motility intestinal obstruction, abnormalities in the intestinal wall muscles and nerve tissues, primary idiopathic intestinal obstruction, symptoms appearing after birth, intermuscular or submucosal There are many nerve plexus and ganglion cells, but the neuron development is abnormal, the number is reduced, the morphology is small, and the smooth muscle fibers of the intestinal wall can be found under the electron microscope. The vacuolar degeneration can be found, and there is no obvious incentive for dynamic intestinal obstruction. And the conduction of inhibition is not normal.
Prevention
Pediatric dynamic intestinal obstruction prevention
The primary etiology is still under study, there is obvious family genetic predisposition, and should be consulted with genetic diseases, secondary to enteritis, sepsis, pneumonia, hypokalemia, drug poisoning, etc., should actively treat the primary disease, in case Inflammation of the intestines aggravates the condition, and the disease disappears as the primary disease progresses.
Complication
Pediatric dynamic intestinal obstruction complications Complications, dehydration, metabolic acidosis
Often complicated by dehydration, acidosis, chronic, persistent episodes can be to children with nutritional disorders, growth retardation and so on.
Symptom
Pediatric dynamic intestinal obstruction symptoms common symptoms abdominal distension abdominal pain constipation fecal vomit intestinal paralysis weight loss aphid intestinal obstruction dyspnea
Mainly manifested as chronic, recurrent or persistent, with paroxysmal intestinal obstruction syndrome, without intestinal obstruction, the symptoms can occur at any age, the younger the age, the more severe the symptoms, the longer the duration .
Secondary dynamic intestinal obstruction
Clinical manifestations are more critical, with abdominal pain, bloating, vomiting and no defecation. The symptoms at the onset are different according to the disease causing intestinal paralysis. After the formation of paralysis, there is full abdominal distension, and the bowel sounds are scarce or disappearing. It may cause difficulty in breathing due to abdominal distension. There is no vomiting in the early stage, and vomiting occurs after the abdominal distension is aggravated. The stool is contained, and the number of bowel movements is reduced until the bowel movement cannot be exhausted.
2. Primary motility intestinal obstruction
The main clinical manifestations are subacute, chronic, recurrent, or persistent intestinal paroxysmal syndrome, vomiting, bloating, constipation as its main symptoms, light and heavy, mild vomiting symptoms, a small amount Exhaust defecation, but bloating is difficult to disappear, sick children due to long-term nutritional malabsorption, are thinner and thinner, abdominal shape bulging, bowel sounds weak or disappear.
Examine
Pediatric dynamic intestinal obstruction examination
In addition to the three major routines, blood biochemical tests should pay attention to the presence or absence of electrolyte imbalance. Blood sodium, potassium, chloride, calcium and blood pH should be routinely checked. If necessary, thyroid function should be measured to determine whether there is a hypothyroidism.
X-ray diagnosis
Is an important diagnostic method, fluoroscopy or abdominal plain film performance of different degrees, different parts of the intestinal obstruction X-ray signs, gastrointestinal barium meal is an important means of exclusion of mechanical intestinal obstruction, dynamic intestinal obstruction, visible proximal bowel dilatation And the phenomenon of stagnant stagnation, the standing position and the lying flat film can be seen in the small intestine and colon evenly expanding and inflating, there is a liquid level, if you can not decide whether the inflatable intestinal fistula is colon, you can use a small amount of tincture low-pressure enema, such as the colon Inflated expansion, the diagnosis of intestinal paralysis can be determined.
2. Special inspection
Gastrointestinal pressure measurement and gastrointestinal electrogram examination are effective methods for the diagnosis of dynamic intestinal obstruction. Rectal pressure measurement biopsy excludes congenital megacolon.
Diagnosis
Diagnosis and diagnosis of pediatric dynamic intestinal obstruction
diagnosis
The diagnosis of dynamic intestinal obstruction can be based on the following points:
History
(1) With or without abdominal trauma, history of peritonitis and drug poisoning: abdominal trauma, retroperitoneal hematoma can stimulate intestinal obstruction caused by retroperitoneal autonomic nerve, abdominal surgery, especially with peritonitis, more than 1 to 2 days after surgery In the paralysis stage, the more complicated the operation, the more severe the peritoneal reaction, the longer the paralysis time, the symptoms of intestinal obstruction, and (2) the presence or absence of systemic diseases such as pneumonia, sepsis, nervous system infection, and enteritis.
(3) Whether the symptoms of intestinal obstruction begin spontaneously.
2. X-ray diagnosis
X-ray examination is very helpful for diagnosis. The flat and rectal plains can be seen in the small intestine and colon. The liquid is flat. If it is not possible to determine whether the inflated intestinal fistula is colon, a small amount of tincture can be used for low-pressure enema. Inflated dilation, the diagnosis of intestinal paralysis can be determined, and the expectorant of the barium meal can be seen stagnant.
3. Special inspection
Blood biochemical examination for electrolyte imbalance such as blood sodium, potassium, chlorine, carbon dioxide binding, blood calcium, plasma protein, etc., whether the thyroid function is measured or not, rectal pressure measurement biopsy except congenital megacolon.
Differential diagnosis
Should be noted with the identification of congenital megacolon, rectal pressure measurement biopsy can be identified; and should be differentiated from mechanical intestinal obstruction.
