Ascaris intestinal obstruction in children
Introduction
Introduction to pediatric aphid intestinal obstruction Ascaris is one of the most common intestinal parasitic diseases in China. It is more common in school-age children and can cause complications such as aphid intestinal obstruction, biliary aphid and aphid peritonitis. Aphid intestinal obstruction is caused by the mechanical blockage of the intestine caused by agglomeration of aphids. The most common non-neoplastic obstructive intestinal obstruction is simple and partial intestinal obstruction. The most common site of obstruction is the end of the ileum. But it can happen in any part of the small intestine. basic knowledge The proportion of children: the incidence rate of children is about 0.01% - 0.02% Susceptible people: children Mode of infection: non-infectious Complications: peritonitis
Cause
Causes of aphid intestinal obstruction in children
Causes:
When the body is infected with aphids, the aphids are parasitic in the intestine. When the parasitic host environment and intestinal dysfunction, the aphids are stimulated, the excitability is increased, the activity is enhanced in the intestines, and they are twisted into a mass, which easily blocks the intestines and causes the intestines. obstruction.
Pathogenesis:
Aphids are one of the largest nematodes parasitic in the human body. They are 20-40 cm in length and resemble scorpions and dioecious. The fertilized eggs are excreted in human feces and develop into infectious eggs.
About 3 weeks, swallowed into the human body by mouth, hatching into the sputum in the small intestine, moving from the intestine to the heart, lungs, liver, and finally back to the small intestine to develop adults. There are only one locust in the human body, and there are dozens or more.
Under normal circumstances, the mites do not form a mass, and are parasitic in the jejunum and ileum. They live on the chyme in the intestine, are usually quiet, are scattered in the intestinal lumen, and live in parallel with the longitudinal axis of the intestine.
When certain factors cause the mites to be stimulated, enhance the activity, and twist into a mass in the intestine, the contents of the intestine can still pass around the mites, so most of them are incomplete intestinal obstruction.
If the obstruction time is too long, the insects will not scatter, and the intestinal tract will continue to sputum and become a complete intestinal obstruction. The head and mouth of the mites can directly damage the intestinal mucosa, causing the intestinal mucosa to become congested and edematous, and the metabolic poisons stimulate the intestinal wall. The intestine produces reflex spasm and increases intestinal obstruction.
In addition, the metabolites of aphids stimulate the intestinal wall to cause spasm and promote the occurrence of obstruction. The number of aphids required to cause spastic obstruction is small, and sometimes only 1 or 2 aphids and intestinal fistulas can cause intussusception.
Prevention
Prevention of aphid intestinal obstruction in children
1, regular physical examination: to achieve early detection, early diagnosis, early treatment.
2, enhance physical fitness, improve their own immunity: pay attention to work and rest, more to participate in physical exercise, eat more fresh fruits and vegetables rich in vitamins.
Complication
Complications of aphid intestinal obstruction in children Complications peritonitis
Often can be dehydration, acidosis, intestinal necrosis, perforation and peritonitis, septic shock can also occur.
First, intestinal necrosis
Also known as acute necrotic enteritis, alias acute hemorrhagic necrotic enteritis, acute hemorrhagic enteritis, acute segmental hemorrhagic necrotic enteritis. Acute hemorrhagic necrotizing enteritis (AHNE) is a life-threatening fulminant disease with unclear etiology. Its pathogenesis is related to intestinal ischemia and infection, and it is more common in spring and autumn. The onset is rapid, and 1/3 may have a history of unclean diet.
Clinical manifestation
The main symptoms are acute abdominal pain, bloating, vomiting, diarrhea, blood in the stool and systemic poisoning.
The lesion mainly affects the small intestine and is segmental, but in a few cases, all small intestines and colons may be involved, characterized by hemorrhage and necrosis.
Second, intestinal perforation
Intestinal perforation is a pathological change in the intestine that is characterized by necrosis of the intestinal wall, which ultimately leads to perforation.
Clinical manifestation
The symptoms of intestinal perforation are general pain first, and then suddenly increased. However, during the onset of intestinal perforation, a series of symptoms such as fever will occur, such as acute abdominal pain, and peritoneal irritation is very obvious. To the hospital, abdominal wear can be worn to the peritoneal effusion, usually yellow-green liquid, accompanied by There are high fever, white blood cell rise and other performance.
Third, peritonitis
Peritonitis is a serious disease common to surgery caused by bacterial infections, chemical stimuli or injuries. Most are secondary peritonitis, original organ infections in the abdominal cavity, necrotic perforation, trauma and so on.
Clinical manifestation
The main clinical manifestations are abdominal pain, abdominal tenderness, abdominal muscle tension, as well as nausea, vomiting, fever, elevated white blood cells, severe blood pressure drop and systemic toxicity in severe cases. If not treated promptly, it can die of toxic shock.
Symptom
Pediatric aphid intestinal obstruction symptoms common symptoms constipation high fever intestinal fistula abdominal pain abdominal mass bloating dehydration color blue ash aphid intestinal obstruction stop exhaust
Typical symptoms are paroxysmal abdominal pain and vomiting, which can spit out aphids.
Abdominal pain
Most of the initial abdominal pain is paroxysmal, lighter, lazy, unwilling to eat, can say clear abdominal pain in the umbilical cord, abdominal pain is persistent after the disease progresses, the spirit is poor, the complexion is gray, irritated, and some cry loudly call.
Vomiting
Most of them have vomiting after abdominal pain. Most of the vomit is gastric juice and bile. Some even spit out aphids. A few can also have fecal vomit. Generally, there is no coffee or blood in the vomit.
3. Constipation
Most of them have constipation. A few have only a small amount of stool or a small amount of aphids in the initial stage. Some intestinal obstruction is severely caused by ischemia, necrosis, and hemorrhage. A small amount of blood is discharged. If the age is below 2 years old, it needs to be identified with the primary intussusception. After the disease progressed, the exhaust defecation was completely stopped, and the abdominal distension was obvious.
4. Abdominal mass
The abdomen is slightly swelled and soft, and the disease can touch most of the active cord-like masses, and sometimes the mass can be deformed, and the changed parts can be divided into several, which should be differentiated from intussusception, intestinal cysts, abdominal tuberculosis, etc. This has certain discriminative significance with the mass of the intussusception in children. There is no difficulty in early diagnosis. It is difficult to diagnose when the abdominal distension is severe. When the aphid mass does not spread or the aphid has died, the toxin secreted by the aphid stimulates the intestinal wall. Intestinal fistula, intestinal obstruction and swelling, ischemia, necrosis, and even perforation caused by diffuse peritonitis, or because the intestinal aphid mass is too heavy, the intestine is suspended in the mesentery, and the peristaltic disorder is reversed, causing strangulated intestinal obstruction At this time, in addition to the above symptoms worsened with systemic symptoms such as fever, high blood, dehydration, acidosis, and even shock.
5. Intestinal obstruction
The intestinal twist of the mites group is a symptom of acute strangulated intestinal obstruction. The child suddenly has severe abdominal cramps, vomiting, and occasional bloody stools, but the general amount is not too much. The general condition of the child deteriorates rapidly, often with symptoms of poisoning and high fever. , dehydration, abdominal distension with tenderness and muscle tension, occasionally can touch the mass, the condition is often very critical, X-ray abdominal plain film is partial mechanical intestinal obstruction, obstruction site can be seen in the intestinal cavity of the mites shadow (mutual The kinks are a bunch of "whole skein" shadows, which are characterized by complete low-grade small bowel obstruction. There may be X-ray signs of strangulation or suspicious strangulation. The anus of some intestinal obstruction can still be vented.
Examine
Examination of aphid intestinal obstruction in children
In addition to the three major routines, blood sodium, potassium, chlorine, calcium and blood pH should be routinely checked. The total number of white blood cells in the routine blood test is as high as 15×109/L, and eosinophils can reach more than 10%. Aphid eggs can be found.
X-ray inspection
Abdominal plain film is a partial mechanical intestinal obstruction, which may have a strangulated or suspected strangulated X-ray sign. Multiple liquid levels can be seen in the standing position. At the same time, the obstruction site can be seen to distort the shadow of the mites in the intestinal lumen. A cord-like or spotted curled aphid shadow.
2.B type ultrasound examination
Also helpful for diagnosis.
Diagnosis
Diagnosis and diagnosis of aphid intestinal obstruction in children
diagnosis
The sick child has unclean health, improper methods of locust mites, insufficient medication, etc., sick children have paroxysmal umbilical pain, vomiting accompanied by spastic mites, constipation and other symptoms, the abdomen touches the cord-like or flour-like lumps The pressure can be deformed, and those without tenderness should be suspected of aphid intestinal obstruction.
Differential diagnosis
It should be differentiated from intussusception, intestinal cysts, abdominal tuberculosis, etc., and severe abdominal distension and mechanical intestinal obstruction.
Intussusception: refers to a segment of the intestine that is inserted into the lumen of the intestine and causes the contents of the intestine to pass through the barrier.
Mechanical intestinal obstruction: no damage to blood vessels or nerves of simple mechanical obstruction. If it is completely obstructed, the ingested liquid and food, digestive juice and gas accumulate in a large amount, the proximal intestinal tube expands, and the distal intestine segment collapses. Mucosal normal secretion and absorption function is inhibited, intestinal wall edema and congestion, severe intestinal dilatation is self-continuation and progressive, and aggravate intestinal peristalsis and secretion disorder, thereby increasing dehydration, ischemia, necrosis, perforation, peritonitis and death The danger.
