jejunal diverticulum
Introduction
Introduction The jejunal diverticulum is more common than the ileum, often near the Treitz ligament, and can be single, but often multiple. If it is multiple, the number in the lower intestine is gradually reduced, the volume is also small, sometimes only a small protrusion, but it is not uncommon in the end of the ileum. About 30% have a duodenal or colonic diverticulum, and congenital diverticulum often incorporates other congenital malformations. Most of the diverticulum is located on the mesenteric side, between the two mesenteric mesles, or near the mesentery, and also on the opposite side of the mesentery. The jejunal diverticulum is rare, and it lacks typical clinical symptoms, which may lead to misdiagnosis or missed diagnosis.
Cause
Cause
Jejunal diverticulum is often acquired and is associated with increased intra-abdominal pressure. Changes usually associated with small bowel movements, such as progressive systemic sclerosis, visceral disease and neuropathy, can lead to atrophy and fibrosis of the small intestine, which causes the intestinal wall to expand cystically and break into the submucosa from the weak muscle layer. Visceral neuropathy causes dysmotility of the small intestine, causing high pressure in the intestinal lumen, causing diverticulum in the weak part of the large blood vessels entering the muscular layer, sometimes causing paralytic ileus. Krishnamurthy (1983) had a histological study and found that the number of muscle cells in the empty and ileal muscle layers was reduced and degenerative or fibrotic, and some neurons and neurites in the intermuscular plexus also showed degenerative changes. The disease may be the manifestation of systemic sclerosis in the small intestine.
Examine
an examination
Related inspection
Fibrous colonoscopy colonography gastrointestinal CT examination of gastrointestinal imaging
The clinical symptoms of this disease lack specificity. For those who are 60 to 80 years old, there are long-term digestive disorders, often with flatulence, pain or cramps in the stomach, or diarrhea, megaloblastic anemia, etc. should be thought of. Upper gastrointestinal sputum angiography showed that the small mesenteric side has a round or oval shape, a smooth and smooth bag-like shadow, or a large diverticulum cavity showing a three-layer plane image of gas, liquid and tincture. Clear diagnosis. For patients with suspected gastrointestinal bleeding, radionuclide examination, selective superior mesenteric artery angiography, etc. can assist in diagnosis.
1. Small intestine gas sputum double contrast examination
Small bowel angiography has a higher rate of diagnosis. The test catheter was inserted into the duodenal jejunum, and a 50% (w/v) suspension of 300-400 ml was injected through the catheter. After the expectorant reached the ileocecal area, an appropriate amount of air and intramuscular injection of the expectorant were injected. The small intestines of each group are gently pressed in sections, and a variety of body positions are required to operate, so that the tincture can fill the diverticulum that is open in various directions. The developed diverticulum has a round or oval-shaped shadow on the mesenteric side of the small intestine, and the edges are neat and smooth, and open to the intestine cavity with wide and narrow openings. The larger diverticulum chamber can display the three layers of gas, liquid and sputum. If the diverticulum with wide opening is visible, the contrast agent can enter and exit freely between the diverticulum and the intestine. This is the characteristic X-ray manifestation of this disease.
2. Radionuclide imaging diagnosis
Cases of complicated gastrointestinal bleeding can be diagnosed by 99mTc red blood cell imaging. The venous injection of 99mTc-labeled red blood cells was 550-740MBq, and the images were immediately acquired by gamma camera or SPECT system at a rate of 1 frame/5 minutes for 30 minutes, and then the anterior-posterior and lateral images of the abdomen were collected 1 hour and 2 hours later. Delay imaging after 6 hours if necessary. When the amount of bleeding in the intestinal wall is 0.1 ml/min, the marked red blood cells flow into the intestinal lumen with the blood to form an abnormal radioactive aggregation phenomenon. This method can perform bleeding localization and continuous dynamic observation. The positive diagnosis rate can reach 75% to 97% when multiple imaging is performed within 24 to 36 hours. The examination of this method to determine the location of the bleeding in the upper part of the jejunum can prompt the diagnosis of this disease.
3. Selective superior mesenteric artery angiography
Technically excellent angiographic examinations are valuable for large numbers of bleeding cases. The bleeding rate is >0.5ml/min, and the contrast agent in the intestinal lumen clearly shows the bleeding site, and even directly shows the nature of the lesion.
4. Fiber enteroscopy
Some authors recommend that fiberoptic enteroscopy can be used for direct observation of small intestine diseases, and there is a high rate of diagnosis. The mastery of this technology is highly specialized and needs to be further promoted.
Diagnosis
Differential diagnosis
This disease should be differentiated from peptic ulcer bleeding and perforation, mechanical intestinal obstruction when the mucosal hemorrhage, diverticulum perforation, pneumoperitoneum and small intestinal wall balloon or intestinal obstruction occur.
