Duodenal dilatation

Introduction Duodenal dilatation and dysthymia are syndromes that prevent the chyme from passing through the duodenum for a variety of reasons. Blockage often occurs in the third and fourth segments of the duodenum, and the intestines above the obstruction have dilatation and retention of the chyme. The main clinical manifestations are signs of high intestinal obstruction. Although this disease is rare, it can cause serious consequences due to delay in treatment due to lack of timely diagnosis. Therefore, it should have sufficient knowledge of this disease.

Cause

The duodenal transverse and ascending parts are located behind the retroperitoneum and are the most fixed part of the digestive tract. They traverse from the right to the left across the third lumbar vertebrae and the abdominal aorta. The distal end of the duodenum is fixed by the duodenal suspensory ligament, which is anteriorly traversed by the superior mesenteric vascular bundle in the mesenteric root. The superior mesenteric artery is usually separated at the level of the first lumbar vertebrae and is at an angle of 30°-40° to the aorta. If the angle is smaller, the superior mesenteric artery can press the transverse and ascending portions of the duodenum to the vertebral body or the abdomen. On the arteries, causing stenosis or obstruction of the intestine. The small angle caused by the above is the result of a variety of factors, such as the duodenal suspensory ligament is too short to fix the distal end of the duodenum at a higher position, the superior mesenteric artery at the beginning of the narrow angle, the origin of the superior mesenteric artery The position of the abdominal aorta is too low. In the duodenum crossing the vertebral body in front of the vertebral body with abnormal walking of the superior mesenteric artery, in addition, lumbar lordosis, duodenal suspensory ligament and mesenteric root adjacent lymph node inflammatory enlargement, weight loss caused by mesenteric and posterior peritoneal fat reduction As well as visceral drooping, etc., the gap between the spine and the superior mesenteric artery root can be reduced, and the transverse part of the duodenum is easily compressed.

an examination

Related inspection

Colonoscopy fiber enteroscopy

It is characterized by fullness of the upper abdomen after full meal or vomiting after meal, as well as dyspepsia such as hiccups and nausea. The diagnosis of this disease requires a gastrointestinal barium examination. It can be seen that the first and second parts of the duodenum are dilated, and there is repeated strong reverse peristalsis. The expectorant can be refluxed into the stomach. The swallowed tincture cannot be emptied from the duodenum after 2 to 46, indicating that there is an obstruction. For example, if there is a neat oblique line in the transverse or ascending part of the duodenum and the obstruction of the expectorant, it may indicate the possibility of superior mesenteric artery compression syndrome; if the patient takes a prone or left lateral position, the duodenum The retention disappeared and the diagnosis was confirmed. If necessary, aortic angiography and barium meal examination can be performed simultaneously, showing the relationship between duodenal compression and superior mesenteric artery.

Differential diagnosis

Differential diagnosis of duodenal dilation:

1. The congenital giant duodenum caused by nerve imbalance, the mechanism is similar to achalasia or congenital megacolon.

2, congenital adhesions caused duodenal, duodenal jejunum or the first segment of the intestine was distorted.

3, small intestine or colon insufficiency causes the cecum to cross the front of the duodenum and cause compression obstruction.

4, duodenum congenital abnormalities. Most of the day after tomorrow is mechanical obstruction, such as:

1 benign or malignant tumor.

2 stomach, duodenal ulcer.

3 foreign stones such as gallstones and parasites.

4 annular pancreas compresses the descending part of the duodenum.

5 mesenteric lymphadenopathy caused by gastric cancer or pancreatic cancer, or lymph node tuberculosis distributed along the mesenteric blood vessels, causing duodenal compression.

6 The duodenum is compressed by the superior mesenteric artery, ileal colon artery or right colon artery. Among them, the superior mesenteric artery caused by the transverse pressure of the duodenum is more common, also known as the superior mesenteric artery compression syndrome.

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