congenital bowel atresia and stricture
Introduction
Introduction to congenital intestinal atresia and stenosis Congenital intestinal atresia and stenosis is the development of intestinal duct in the embryonic stage. During the re-tubing process, part of the intestinal tract is terminated and the intestinal lumen is completely or partially blocked. Complete obstruction is atresia, and partial obstruction is stenosis. It can occur in any part of the intestine, but it is most common in the ileum, followed by the duodenum, and the colon is rare. It is one of the common causes of intestinal obstruction in newborns. basic knowledge Sickness ratio: 0.05% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: congenital esophageal atresia hypospadias
Cause
Congenital intestinal atresia and stenosis
Congenital factors (55%):
Intestinal cavitation in the solid stage of embryonic development can produce intestinal atresia or stenosis. The blood supply disorder of a certain part of the intestine of the fetus, such as fetal volvulus, intussusception, fetal fecal peritonitis and adhesional intestinal stenosis, intestinal perforation, internal hemorrhoids, mesenteric vascular developmental malformation caused by a certain blood vessel disorder in the intestine The intestinal tube undergoes necrosis, absorption, repair and other pathophysiological processes to form intestinal atresia.
Other disease factors (45%):
Beijing Children's Hospital has seen 7 cases of intestinal atresia, intestines in the intestine of the resected specimens, and multiple cases of intestinal atresia with intra-abdominal adhesions and scattered calcifications. Congenital intestinal atresia is most common in the lower jejunum. And the ileum, the duodenum is second, the colon atresia is relatively rare, while the intestinal stenosis is the most duodenum, the ileum is less, there are two pathological forms of intestinal atresia: one is membrane-type atresia, and there is a diaphragm in the intestine The intestinal cavity is blocked to form a occlusion, which is more common in the duodenum and jejunum. The appearance still maintains its continuity. The appearance of the other intestinal tube loses its continuity, or only one fiber cord is connected, and the intestinal tube at both ends of the obstruction is blind. More common in the lower jejunum and ileum, single occlusion is more common, there are multiple occlusions accounted for about 7.5% to 20%, the closure of the proximal intestinal tube due to long-term obstruction and expansion, diameter up to 3 ~ 5cm, intestinal wall hypertrophy, can also occur locally Anemia, necrosis, perforation, distal intestine small contracture diameter 4 ~ 6mm, no gas in the cavity, only a small amount of mucus and shedding cells, if intestinal atresia occurs after the formation of fetus, there may be a small amount of black and green fetus at the distal end of the lock .
Prevention
Congenital intestinal atresia and stenosis prevention
The prognosis of intestinal atresia is related to the position of atresia. Simple atresia, high jejunum distal and ileum proximal atresia have a high survival rate. In recent years, the mortality of intestinal atresia has decreased significantly. The domestic survival rate is 51.3%~73.3%, and the foreign country is about 70%-85. %, low birth weight, and other malformations have lower survival rates.
Complication
Congenital intestinal atresia and stenosis complications Complications congenital esophageal atresia hypospadias
Intestinal atresia often complicated with other malformations, such as congenital anal atresia, congenital esophageal atresia, congenital heart disease, hypospadias, etc., the proximal intestinal tube is blocked due to long-term obstruction, the diameter can reach 3 to 5 cm, the intestinal wall is hypertrophy, also The length of the small intestine in children with local anemia, necrosis, perforation and intestinal atresia can be significantly shortened compared with normal newborns, generally 100-150 cm long and 250-300 cm in normal children.
Beijing Children's Hospital has seen 7 cases of intestinal atresia, intestine intussusception in the intestine of the resected specimen, and multiple cases of intestinal atresia with intra-abdominal adhesions and scattered calcifications.
Symptom
Congenital intestinal atresia and stenosis symptoms common symptoms nausea and vomiting dehydration abdominal distension intestinal stricture intestinal atresia
Congenital intestinal atresia and intestinal stenosis are prominent manifestations of vomiting. Frequent vomiting occurs in a few hours to 1-2 days after birth. In most cases, vomit contains bile, and in a few cases, vomit is old bloody. Normal meconium discharge, or only a small amount of gray-green jelly-like stool, high intestinal atresia or stenosis is generally no bloating, only the upper abdomen is slightly full; low intestinal atresia or stenosis is obvious bloating, and even intestinal type, severe vomiting can be seen Dehydration, acid-base imbalance and electrolyte imbalance, X-ray abdominal plain film, high atresia or severe stenosis can be seen in the stomach and duodenum with 2 to 3 liquid levels, while the jejunum is not inflated; low atresia or severe stenosis can be seen Most enlarged bowel and liquid level.
Examine
Congenital intestinal atresia and stenosis
Abdominal X-ray films showed intestinal gas accumulation and gas-liquid surface, and barium enema or nasal feeding sputum angiography can confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of congenital intestinal atresia and stenosis
Newborns begin to have persistent vomiting after birth, no normal meconium discharge or progressive abdominal distension, that is, there may be suspected intestinal atresia, such as anal finger test and warm saline or 1% hydrogen peroxide solution enema still not normal Fetal stools can further exclude fecal constipation and congenital megacolon. In the past, the Farber test was used to check the non-keratinized epithelial cells and fetal hair in meconium to diagnose intestinal atresia. It has diagnostic value for the formation of intestinal atresia within 3 months. In the middle and late fetuses, there is no diagnostic significance for intestinal atresia due to mechanical or vascularity. Abdominal X-ray plain films have great value in diagnosis. High intestinal insufficiency standing X-slices can be seen in the upper abdomen. The liquid level, other intestines are not inflated at all, the lower intestinal obstruction can be seen to enlarge the intestinal curvature and the liquid level, the barium enema can be seen in the small constricted fetal colon, the characteristics of the fetal colon:
1 diameter is about 0.5cm;
2 colonic creases are not obvious;
3 The colon is relatively straight and short, and the results of the barium enema can exclude the congenital megacolon and poor intestinal rotation.
