Gastrointestinal foreign body and foreign body intestinal obstruction in children
Introduction
Brief introduction of gastrointestinal foreign body and foreign body intestinal obstruction in children Acute intestinal obstruction caused by foreign bodies in the digestive tract of children is mainly blocked by feces, and occasionally caused by accidental swallowing of foreign bodies or eating food that cannot be digested. Children, especially young children, like to put their toys and all kinds of things in their mouths, but they can swallow their foreign bodies into the digestive tract by laughing and crying. Therefore, children's digestive tract foreign bodies are more common in adults, and fecal stone obstruction, mostly due to poor defecation in children. Get used to or ingest a large amount of non-digestible food with a core, so that it can accumulate in the small intestine or colon and can not be discharged, resulting in intestinal obstruction. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: peritonitis abdominal cramp syndrome
Cause
Pediatric gastrointestinal foreign body and foreign body intestinal obstruction
(1) Causes of the disease
Foreign bodies entering the gastrointestinal tract are foreign bodies in the gastrointestinal tract. About 95% of the foreign bodies that can enter the gastrointestinal tract through the esophageal stenosis can be excreted. Among them, esophageal foreign bodies are the most common, followed by the stomach and intestines, and the digestive tract foreign bodies are divided into 3 class:
1. Exogenous: Because children have foreign objects in the mouth to play, inadvertently swallowed into the digestive tract, but also swallowed by mental abnormalities, but rare in children, there are many types of foreign bodies, according to their nature can be divided into metallic and Non-metallic two types, metallic: coins, pins, screws, jewelry, nails, knives, sewing needles, pushpins, keys, badges, etc.; even more, there are toy cars, small planes, etc., non-metal Sexuality: fruit core, bone piece, button, building block, glass, meat group, fishbone, hard plastic, etc. Some people have summarized 62 pieces of upper digestive tract foreign body taken out by gastroscope, 23 pieces of metal, 13 pieces of glass, hard There are 6 pieces of plastic, 9 pieces of fruit core and 11 pieces of meat bolus, which illustrate the diversity of exogenous foreign bodies.
2. Endogenous: This foreign body is rare in children. It is produced outside the digestive tract of the body, such as gallstones, enters the stomach through the gallbladder-duodenal fistula, or enters the intestine. It is reported that the intestine is caused by gallstones. In the obstruction, the mites enter the stomach or esophagus through the pylorus, and are also endogenous foreign bodies.
3. Format formation in the digestive tract: mostly due to the ingestion of a large number of fiber-rich foods, fruits, or swallowed hair in a short period of time, and agglomeration formed in the stomach or intestine through the action of the digestive tract and digestive juice. The stomach is called "stomach stone", and the intestine is called "fecal stone". The clinical manifestations and treatment methods of foreign bodies in the digestive tract are closely related to the nature of the foreign body and the incarcerated part. Most foreign bodies can be discharged smoothly, and a few difficulties The patient can be tried with a gastroscope, and only a few individual cases require surgical treatment.
(two) pathogenesis
Pediatric gastrointestinal foreign body is most common, followed by stomach stone and fecal stone, rare endogenous, foreign matter into the gastrointestinal tract is the gastrointestinal foreign body, larger foreign body can cause gastrointestinal obstruction, and sharp foreign body It can cause bleeding due to damage of gastrointestinal mucosa and abrasion of the anus. Sharp foreign matter can also be stuck on the wall of the stomach or intestine, and even cause perforation. It enters the abdominal cavity and sticks to the surrounding organs after perforation. Therefore, severe peritonitis is rare, foreign body Too long can not pass the duodenal koji, toxic or corrosive foreign matter can cause serious complications, endogenous foreign bodies, such as gallstones, reported intestinal obstruction in adults, children are rare, stomach stone and fecal stone This section will be devoted to discussion.
Prevention
Pediatric gastrointestinal foreign body and foreign body intestinal obstruction prevention
Foreign bodies in the gastrointestinal tract are completely preventable, and parents and nurses should be widely educated to strengthen infant and child care.
Children under the age of 1.3 have not yet erupted, and should not be given peanuts, seeds, beans and other foods with nuclear.
2. Do not choose toys that are dangerous for children. They should not be used as toys for items that children may swallow.
3. Do not run around when eating in children, so as not to swallow foreign objects when falling.
Complication
Pediatric gastrointestinal foreign body and complications of foreign body intestinal obstruction Complications peritonitis abdominal cramp syndrome
Larger or sharp foreign bodies can cause abdominal cramps, bleeding, intestinal perforation and peritonitis, and can also be complicated by stomach or intestinal obstruction.
Symptom
Pediatric gastrointestinal foreign body and foreign body intestinal obstruction symptoms common symptoms indigestion nausea and vomiting nausea pain abdominal pain abdominal discomfort appetite loss aphid intestinal obstruction peritonitis
Round, oval or cuboid gastrointestinal tract foreign bodies, under normal circumstances, can be quickly excreted from the rectum, so the children are asymptomatic, individual sharp and slender objects, such as needles, spikes, Open needles, etc., rarely pierce the intestinal wall and stomach wall, even if the puncture, because it gradually wears out the digestive tract, can be surrounded by cellulose, does not form acute perforating peritonitis, in most cases, these foreign bodies All of them can be transferred to their blunt ends and discharged to the outside, without harm to children. X-rays can be used to track the direction of non-X-rays through foreign bodies. If the foreign body penetrates the X-ray, the tincture can be swallowed to observe whether there is any filling. Defect, if the foreign body is too long in a fixed time, it can not be excreted by itself. If the fecal stone causes intestinal obstruction, the symptoms of simple intestinal obstruction usually occur, the onset is slow, the early abdomen has discomfort, and the umbilical cord occurs later. Pain, abdominal pain gradually increased, when the obstruction is relatively complete, there is frequent vomiting, stomach stone retention in the stomach, can cause indigestion, nausea, vomiting, loss of appetite, stomach discomfort, mild abdominal pain and other symptoms, in the upper abdomen examination , And more palpable lumps great activities, small intestine bezoar is difficult to touch, rectum were rectal examination can touch the huge hard fecal matter.
Examine
Pediatric gastrointestinal foreign body and foreign body intestinal obstruction examination
When there is inflammation, there are peripheral blood leukocytes, neutrophils increased; ascites, acidosis, should be routine blood biochemical examination, check blood sodium, potassium, chlorine, calcium and blood pH.
1. X-ray examination: Blocking the foreign body can take the front position and the lateral position to determine the position and shape of the foreign body, and not block the foreign matter. When the film is taken, it can swallow or swallow the tincture with cotton fiber to make it contain The ray fiber is attached to foreign matter for development and can track its tracks, but the following points should be noted:
(1) X-ray examination is negative and foreign matter cannot be excluded.
(2) The residual of the tincture after swallowing affects the observation and clamping of the endoscope.
(3) In the event of perforation, the spread of tincture to surrounding tissues can have serious consequences.
2. Fiber endoscopy: The shape, nature and position of the foreign body can be directly viewed. At the same time, the foreign body can be used to remove the foreign body. It is generally considered that the use of gastroscopy for the treatment of children's esophageal foreign body is safe and reliable.
Diagnosis
Diagnosis and diagnosis of foreign body and foreign body intestinal obstruction in children
diagnosis
1. The history of foreign bodies asks about the nature of foreign bodies, the reasons for swallowing, time, circumstantial evidence, past history, etc.
2. Symptoms and signs (above).
3. Auxiliary examination can help diagnose.
Differential diagnosis
When causing stomach or intestinal obstruction (endogenous foreign body), pay attention to the identification of obstruction caused by other causes, cause perforation and peritonitis and appendicitis, tuberculous peritonitis, etc., but even if perforation occurs, because there are often omentum around Adhesion of the liver or other organs can prevent sharp foreign bodies or infectious substances from leaking into the abdominal cavity. Therefore, abdominal pain, muscle tension, tenderness, rebound tenderness and other muscle-vigiling phenomena are not very serious. Wang Lizhu and others have reported a 12-year-old girl. Intestinal perforation, peritoneal infection, adhesion, clinical manifestations of fever, abdominal pain, mild abdominal muscle tension, has been diagnosed as "appendicitis", "tuberculous peritonitis", etc., treatment unhealed, laparotomy found 3 7 No. sewing needle (about 3cm long), one is located on the right upper ventral side of the peritoneum, the other two are located at the junction of the duodenum and the jejunum, part of the needle through the intestinal wall, local adhesions into a mass, after removal, the condition Quickly improved, asked the medical history, the child had several needles in the mouth a few months ago, accidentally swallowed during the conversation, and did not care if there was no discomfort afterwards. The child did not realize the seriousness of the swallowing needle and was asymptomatic after swallowing the needle. will The history of swallowing needles has been forgotten, resulting in complications such as perforation and infection. Misdiagnosis lasted for 7 months and delayed treatment. Large foreign bodies can also cause stomach or intestinal obstruction. Gastric obstruction can manifest as upper abdominal pain, bloating and Vomiting.
