Duodenal Obstruction

Introduction to duodenal hoarding Duodenal stagnation syndrome, duodenal hoarding disease, refers to the duodenal obstruction caused by various causes, resulting in the proximal end of the duodenal obstruction, the clinical syndrome caused by food accumulation. Mainly for upper abdominal pain and fullness symptoms, mostly during or after eating, nausea, vomiting, bile, and sometimes vomiting to relieve symptoms due to upper abdominal fullness. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: dehydration malnutrition

Cause of duodenal hoarding

There are many causes of this disease. The upper mesenteric artery is used to compress the duodenum to form a hoarding (50%). This condition is also called superior mesenteric artery syndrome. Other reasons are

Congenital anomalies (20%):

Such as congenital peritoneal ligament compression to block the duodenum; congenital stenosis or occlusion of the duodenum distal, annular pancreatic compression of the duodenum descending; duodenal dysplasia The duodenum, as well as the duodenum, are severely sag due to congenital variation, and the duodenal jejunum can be folded to close it, resulting in hoarding.

Tumor (20%):

Good duodenal and malignant tumors; retroperitoneal tumors such as kidney tumors, pancreatic cancer, lymphoma; metastatic carcinoma of the duodenum, adjacent enlarged lymph nodes (carcinoma metastasis), mesenteric cysts or abdominal aortic aneurysm compression Refers to the intestines.

Inflammation (12%):

Distal or proximal jejunal invasive disease and inflammation of the duodenum; such as progressive systemic sclerosis, Crohn's disease, and dilated stenosis or compression caused by diverticulum.

Postoperative adhesions (15%):

Adhesion of the duodenum after gallbladder and stomach surgery; adhesion, ulcer, stenosis or sputum syndrome after gastrojejunostomy.

Other congenital malformations (18%):

Duodenal inversion, duodenal obstruction caused by gallbladder duodenal colon cord; duodenal anterior portal vein; abnormal position of Fauter's ampulla (common bile duct opening in the third part of the duodenum) .

The transverse section of the duodenum is located in the retroperitoneum, spanning from the right to the left across the third lumbar vertebrae and the abdominal aorta. The anterior segment of the duodenum is traversed by the superior mesenteric vascular bundle in the mesenteric root. If the angle between the two is too small, The duodenum can be compressed, the superior mesenteric artery is generally separated at the level of the first lumbar vertebrae, and the angle of the aorta is 30 ° ~ 42 °, in addition, the following five factors are also the cause of mechanical obstruction:

1 superior mesenteric artery is too long, too short;

2 The superior mesenteric artery is mutated, and the angle from the abdominal aorta is too low or the angle is narrow when it is separated;

3 abnormally large veins in front of the duodenum;

4 lordosis of the spine reduces the space occupied by the duodenum;

5 The length of the intestine of the elongated or visceral sag draws the mesenteric root.

Prevention of duodenal hoarding

Usually, a small amount of meals should be taken. After the meal, the knee chest position is half an hour, and the abdominal muscles are strengthened.

People with stomach, duodenal inflammation, tuberculosis, and cancer should try to eat digestible foods, and avoid abdominal surgery to avoid postoperative adhesions.

Eat foods that are easy to digest, such as porridge, noodles, taro, rolls, buns, clams, soft cakes, soft rice, etc., so slowly and easily digest and absorb.

Eat less foods such as beans, onions, potatoes, sweet potatoes, etc., which are prone to produce acid, avoid cold, avoid greasy, avoid spicy, avoid drinking, and avoid the stimulation of ulcers by bad factors.

Recommended for nourishing the stomach and strengthening the spleen: yam lotus seed lily porridge, peanut red dates millet porridge, can add eggs, minced meat, chicken velvet, fish velvet, broken vegetables, fruit, milk and other flavoring, increase nutrition.

Duodenal complication Complications dehydration malnutrition

If it can not be alleviated, long-term attacks can lead to weight loss, dehydration and systemic malnutrition. Easy to have intestinal obstruction, long-term vomiting can lead to water, electrolyte metabolism disorders.

Symptoms of duodenal stagnation Common symptoms Intestinal hoarding, weight loss, nausea

Acute duodenal obstruction type often occurs when the trunk is fixed or pulled by plaster to cause acute gastric dilatation. Chronic obstruction is the most common type in clinical practice. Hiccup, nausea and vomiting are common symptoms, and more often appear after meals. The vomit contains bile, and the symptoms can be alleviated by changes in body position. For example, when lying on the side, prone, chest and knee, the symptoms can be alleviated. If it can not be relieved, long-term attacks can lead to weight loss, dehydration and systemic malnutrition.

Examination of duodenal hoarding

1X line barium meal examination features: the horizontal part of the duodenum sees the break of the column (sudden vertical cut); the penile movement caused by the strong forward peristalsis and reverse peristalsis of the proximal intestine; the expectorant passes smoothly in the prone position, and the peristalsis disappear.

2 gastroscope can be found in the duodenal cavity obstruction and obstruction in the obstruction site gastroscopy.

3 Selective superior mesenteric artery angiography if necessary, showing the anatomical relationship with the duodenum.

4 dry stomach extraction of duodenal juice often found food residue.

Diagnosis and identification of duodenal hoarding

diagnosis

1 typical symptoms are an important basis for diagnosis.

2X line barium meal examination features: the horizontal part of the duodenum sees the break of the column (sudden vertical cut); the pendulum movement consisting of strong forward peristalsis and reverse peristalsis in the proximal segment of the intestine; the expectorant passes smoothly in the prone position, and the peristalsis disappear.

3 Selective superior mesenteric artery angiography if necessary, showing the anatomical relationship with the duodenum.

Differential diagnosis

Indigestion symptoms need to be differentiated from peptic ulcer, sometimes both can coexist, duodenal tumors such as pancreatic head cancer or giant pancreatic cyst compression caused duodenal deposition, endoscopic or retrograde cholangiopancreatography Surgery can be distinguished, even because of abdominal aortic aneurysm compression of the duodenum caused by this disease, the disease also needs to be with the duodenum stones, hairy stone, mites, foreign body caused by duodenal obstruction Differentiate.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.