Duplication of the digestive tract
Introduction
Introduction to digestive tract repeat malformation Digestive tract repeat deformity refers to a spherical or tubular cavity mass attached to the mesenteric side of the digestive tract and having the same characteristics as the digestive tract. It is a relatively rare congenital malformation. Can occur in any part of the digestive tract, but the most common incidence of ileum, followed by esophagus, colon, duodenum, stomach, rectum, etc., reported in 800 cases, the small intestine accounted for 57.4%, the chest accounted for 19.9 %, the colorectal accounted for 9.9%, the duodenum accounted for 7.1%, the stomach accounted for 3.8%, and the chest and abdomen accounted for 1.8%. Each organ has its predilection site, such as the esophagus in the right posterior mediastinum, the stomach on the large curved side, the duodenum on the medial or posterior side, the small intestine on the mesangial side, the colon on the medial side, and the rectum on the posterior side. . Malformations associated with other systems also have certain rules, such as repeated deformities in the thoracic cavity combined with vertebral deformities such as hemivertebra and spina bifida, and repeated intestinal tracts may be associated with genitourinary malformations. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.002% Susceptible people: infants and young children Mode of infection: non-infectious Complications: intestinal obstruction, gastrointestinal bleeding, abdominal pain
Cause
Digestive tract repeat malformation
(1) Digestive tract re-pipeline chemistry: When re-conserving early in the embryo, the intracavitary vacuoles fuse. If some of the vacuoles are not completely integrated with the intestinal lumen, they can develop into a repeating intestinal tract.
(2) Residual theory of intestinal diverticulum in the fetus: There are many diverticulum-like outer pockets in the early digestive tract of the embryo, which is most common in the distal part of the small intestine. When normal, the diverticulum gradually degenerates and disappears. If there is no degradation or residue during development, it develops. Repeated deformity of the capsule.
(3) Developmental disorders of the notochord: The formation of the notochord in the third week of the embryo, due to adhesion between the endoderm and the ectoderm, causing separation of the neural tube from the intestinal tract, due to the endoderm being pulled, the sacral process occurs, when the endoderm When developed into a bowel, this protrusion develops into a repeating digestive tract of various forms.
(4) Vascular theory: In recent years, many scholars have supported this theory. It is believed that after the development of the fetal intestines, ischemic infarction occurs, leading to intestinal atresia, intestinal stenosis and short intestine. The necrotic residual intestinal tube fragments are subjected to the nutrition of nearby blood vessels, and then self-development can form intestinal repeat deformities. This explanation is also clinically supported, with cases of intestinal duplication with intestinal atresia or stenosis and short bowel.
In short, it is generally believed that its pathogenesis is multi-source, and the deformities of different parts and forms may be caused by different causes.
Prevention
Digestive tract repeat deformity prevention
The disease is caused by abnormal development, so it is impossible to directly prevent the disease against the cause. Early detection, early diagnosis, and early treatment are important for indirect prevention of this disease, and genetic counseling should be conducted. Preventive measures include avoiding the marriage of close relatives, genetic testing of carriers, prenatal diagnosis and selective abortion to prevent the birth of the child. Pay attention to regular B-ultrasound during pregnancy to determine the situation. The disease is congenital malformation and there are no effective preventive measures.
Complication
Digestive tract repeat malformation complications Complications, intestinal obstruction, gastrointestinal bleeding, abdominal pain
The disease may have intestinal obstruction, gastrointestinal bleeding, abdominal mass and abdominal pain, respiratory symptoms and other complications.
Symptom
Digestive tract repeated malformation symptoms Common symptoms Peritonitis Esophageal recurrence Intestinal intussusception Abdominal mass Abdominal pain Stomach repetitive malformation Hemorrhagic cystic mass empyema
Due to the different parts, shape, volume, complications and other malformations of repeated malformations, the clinical symptoms are different, and the symptoms can occur at any age, most of which occur during infancy.
(1) Repeated malformation of the digestive tract in the thoracic cavity can cause respiratory distress caused by compression of the respiratory tract, and obstruction of the esophagus. When the cavity is lined with gastric mucosa, it is caused by inflammation of gastric acid and digestive enzymes, causing inflammation of the adjacent esophagus and lung tissue. Perforation and hemorrhage occur, hematemesis, blood in the stool or empyema.
(B) the stomach repeat deformity, the upper abdomen has a feeling of fullness, vomiting does not contain bile, the right upper abdomen can be sputum and cystic mass.
(C) ileal repeat deformity, large spherical cysts compress the intestinal tract to cause intestinal obstruction, the abdomen can be round and oval, smooth cystic mass, a certain degree of mobility, increased fluid accumulation in the cystic wall leads to the wall Pain and tenderness occur when tension occurs. Small spherical cysts in the muscular layer of the intestinal wall often lead to intussusception. Some repeated deformities can cause intestinal torsion in the attached intestinal segment and cause intestinal necrosis. Tubular malformation is in contact with the intestinal tract. The effusion can be excreted through the intestine, so it is not easy to get a lump. When it is lined with gastric mucosa, it often produces ulcers, hematemesis or blood in the stool, and peritonitis occurs when the ulcer is perforated.
(4) The clinical symptoms of colonic duplication are mild, and the symptoms of low intestinal obstruction may occur in the intestines, accompanied by bright red bloody stools, often accompanied by repeated ureter, bladder, vagina, urethra and rectal anus deformity.
(5) Recurrent duplication of the rectum is difficult to defecate at an early stage. When a bowel is removed from the rectum during defecation, it is a characteristic of rectal globular repeat deformity. In the rectal examination, the rectum can be followed by a cystic mass.
Examine
Digestive tract repeat deformity examination
X-ray examination, spinal angiography, magnetic resonance imaging or CT examination, abdominal B-ultrasound examination is more meaningful for the diagnosis of cystic malformations.
Diagnosis
Diagnostic differential diagnosis of digestive tract
Can be diagnosed based on clinical symptoms and laboratory tests.
Identification of the intestinal cysts in the spinal canal. The wall layer of these cysts is surrounded by the muscular layer of the intestine. The B-ultrasound shows thick-walled cysts, which can be distinguished from the thin-walled mesenteric cyst. The most common cystic malformation in the intestinal wall is diagnosed. difficult. Because the cyst volume is small, the B-ultrasound is not easily diagnosed by the interference of the intestinal gas or the intestinal fluid image. The intussusception induced by this type shows the following characteristics during the air enema reduction process: the intussusception mass is often located in the right abdomen. The intestine segment of the human ascending colon is not long but not easy to reset. Even if the enema is reset, the symptoms of intestinal obstruction are not relieved. At this time, it may be thought that the intussusception induced by the cyst in the intestinal wall may be detected by the 99mTc radionuclide scan containing the ectopic stomach. Repeated malformation of the mucosa has a good diagnostic value, but the ileal repetition is not easily distinguished from the Meckel's diverticulum.
