Symptom >> Internal Medicine >> Gastroenterology

Frequent vomiting and constipation

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Frequent vomiting and constipation are common symptoms of abdominal hernia. The intra-abdominal organ is called the intra-abdominal hernia from its original position, through a normal or abnormal channel or fissure in the abdominal cavity to an abnormal sulcus.

Cause

Cause

According to the pathogenic factors, there are two types of primary and secondary in the abdomen.

(1) primary intraperitoneal hernias: is the intra-abdominal hernia caused by the infiltration of congenital intra-abdominal pores into the abdominal organs.

1 posterior peritoneal hernia: posterior peritoneal hernia is mainly due to the changes in the normal process of small intestine rotation during embryonic development, such as para-duodenal fistula, paracemented sputum, sigmoid colon fistula and bladder sputum.

2 congenital abnormal hiatal hernia: due to the congenital weakened area or abnormal vascular structure of the mesentery or omentum, the weak part of the rupture forms an internal hemorrhoid, such as congenital mesenteric hiatus hernia, retinal hernia and broad ligament Split holes and so on.

Zimmerman et al believe that the posterior peritoneal hernia is a true intra-abdominal hernia, while the latter does not have a hernia sac rather than a true internal hemorrhoid and Pennell believes that the latter is a functional internal hernia. Due to the congenital intra-abdominal space spasm caused by surgery, such as jejunum and transverse mesenteric space after gastrectomy, the sigmoid colon ostomy and lateral abdominal wall gap after Miles surgery should also be functional guilt.

(2) Secondary intraperitoneal hernias: refers to the formation of abnormal, pathological pores following abdominal surgery or abdominal trauma and infection. In some cases, the intestinal fistula protrudes into the internal hemorrhoids. . Including: internal hemorrhoids after partial gastrectomy, internal stenosis after Roux-en-y anastomosis of common bile duct jejunum, internal hemorrhoids after radical resection of rectal cancer, and intra-abdominal adhesion type internal hemorrhoids.

Pathogenesis

During embryonic development, the midgut rotates 270° counterclockwise and the cecum is fixed in the right axillary fossa. The mesenteric root merges with the posterior peritoneum and forms a peritoneal fold at the duodenum, the cecum, and the sigmoid mesenteric root. Called the crypt. If the crypt is large and deep, or the channel (Winslow hole) left during the formation of the omental sac (small peritoneal cavity) is wide, the intestine can be invaded. After 10 weeks of embryos, when the midgut returns to the abdominal cavity, the small intestine can also enter the mesenteric mesentery to form internal hemorrhoids.

In addition, iatrogenic traumatic trauma or infection causes partial defects, displacement, adhesions, etc. of organs and tissues, which change the normal anatomical relationship of the body, create new voids, increase the activity space of abdominal organs and tissues, and intra-abdominal cavity. When the pressure is increased (such as pregnancy, ascites squeeze, strenuous activity, etc.), some organs or tissues with large activities such as small intestine, omental transverse colon and sigmoid colon can be squeezed into the pores to cause secondary intra-abdominal fistula. .

If a large number of mesentery and intestines break into narrow pores, it is difficult to reset by themselves, so that the incarceration of the contents of the intestines is blocked by the infiltration of the intestine wall veins, the intestinal wall edema, the intestinal lumen is dilated, and the intestinal wall is gradually necrotic and perforated. And abdominal infection, severe symptoms of systemic poisoning.

Examine

an examination

Related inspection

Upper digestive tract photography examination of digestive tract photography

Abdominal hernia is rarely seen in clinical manifestations of mechanical intestinal obstruction. No specific preoperative diagnosis of clinical symptoms is quite difficult, and it is often diagnosed after exploratory laparotomy. Strengthen the understanding of the abdominal hernia and its alertness, familiar with its symptoms and signs, patients with intestinal obstruction should be highly alert to the possibility of abdominal hernia.

History

(1) The patient had a history of chronic, incomplete or complete intestinal obstruction, such as intermittent upper abdominal pain, nausea, vomiting, bloating, etc., after eating, no remission was aggravated, and over-extension or flexion of the trunk can aggravate the symptoms. Get better or the symptoms and signs disappear.

(2) Sudden conversion to acute complete obstruction on the basis of general chronic intestinal obstruction cannot be explained by other reasons.

(3) The onset is sudden and sharp, and the abdomen touches the mass. In the past, there was no history of abdominal mass, which could exclude intestinal obstruction caused by other causes such as intestinal torsion, intussusception, and intestinal tumor.

(4) Patients with acute intestinal obstruction, who have the above clinical manifestations and have a history of chronic abdominal pain without a history of surgery, should consider congenital intra-abdominal fistula. If there is a history of gastrointestinal surgery, the possibility of acquired abdominal hernia should be considered.

2. Clinical features

(1) Abdominal pain: The internal hemorrhoids secondary to abdominal surgery have severe abdominal pain; accompanied by strangulated intestinal obstruction, abdominal pain is persistent and paroxysmal aggravation; retinal sac and crypt nevus can cause chronic simpleness Intestinal obstruction, mostly mild abdominal pain.

(2) vomiting and constipation: duodenal paralysis, postoperative gastrectomy, and other high-level internal hemorrhoids have frequent vomiting and constipation. Non-incarcerated intra-abdominal hernias such as crypts and reticular sacs are mostly nausea and vomiting and constipation.

(3) abdominal distension and mass: incarcerated abdominal inguinal hernia can cause abdominal distension, retinal sac, and duodenal paralysis, which can form a mass in the upper abdomen and localized abdominal distension, and the percussion is drum sound, other types Most of the guilt cannot touch the lumps.

(4) Internal hemorrhoids after abdominal surgery: When the bowel function is restored and begins to eat, sudden severe abdominal pain and vomiting, cessation of defecation and venting, and signs of paleness, rapid pulse rate and coldness of the limbs and other signs of shock and peritoneal irritation.

3. Auxiliary diagnosis

X-ray barium angiography is helpful for the diagnosis of internal hemorrhoids and can identify the location and type of internal hemorrhoids. In order to avoid aggravating intestinal obstruction, a safer water-soluble iodine can be used for angiography. After the formation of intestinal obstruction, the abdominal X-ray film can show multiple levels. Mesenteric angiography can aid diagnosis. B-ultrasound can detect abnormal gas accumulation in a certain part of the abdomen or see a small group of small intestines gather together, not easy to be moved, similar to being packed in a bag.

Diagnosis

Differential diagnosis

Gastrointestinal obstruction is caused by intra-abdominal spasm, and it is mostly simple and becomes strangulated. It is often difficult to make a correct diagnosis because of internal sputum. Therefore, when suspected of this disease, it should first be differentiated from other common intestinal obstruction. Early omental hernia and duodenal paralysis with paroxysmal cramps and nausea and vomiting should be differentiated from acute gastric torsion and acute pancreatitis.