Ascaris intestinal obstruction

Introduction Aphid intestinal obstruction is caused by the mechanical blockage of the intestinal tract caused by agglomeration of aphids. It is the first in non-neoplastic occlusive intestinal obstruction, mostly simple and partial intestinal obstruction. Under normal circumstances, the aphids parasitic in the intestine are scattered, parallel to the longitudinal axis of the intestine, and generally do not cause obstruction. However, when the mites multiply or some physiological changes occur in the human body, such as elevated body temperature, diarrhea, intestinal dysfunction, allergic constitution, and increased irritation caused by various stimuli or insufficient dose of deworming agents, aphids can be induced. The turmoil, gathering, and kinking into a group caused blockage of the intestinal lumen.

Cause

(1) Causes of the disease

Under normal circumstances, the aphids parasitic in the intestine are scattered, parallel to the longitudinal axis of the intestine, and generally do not cause obstruction. However, when the mites multiply or some physiological changes occur in the human body, such as elevated body temperature, diarrhea, intestinal dysfunction, allergic constitution, and increased irritation caused by various stimuli or insufficient dose of deworming agents, aphids can be induced. The turmoil, gathering, and kinking into a group caused blockage of the intestinal lumen. The number of mites causing mechanical intestinal blockage varies from tens to thousands, and authors report that 20,097 mites were removed from the intestine of a patient. In addition, the metabolites of aphids stimulate the intestinal wall to cause spasm and promote the occurrence of obstruction. The number of aphids required to cause spastic obstruction is small, sometimes only 1 or 2. Aphid colons and intestinal fistulas can also cause intussusception.

(two) pathogenesis

Pathogenesis

Aphids that are twisted into agglomerates, due to mechanical stimulation and toxins produced by aphids, cause intestinal fistula, intestinal contents cannot pass through the intestines, and because of the narrow intestinal tract, or the accumulation of aphids, a series of intestinal and systemic pathologies are caused. And physiological changes. Adults are mainly parasitic in the middle lumen of the jejunum, and their toxic effects may be the absorption of antigens (from live or dead aphids), causing LgE-mediated allergic reactions. Aphids can mechanically damage the intestinal mucosa of the host, and its metabolites can also stimulate and damage the local mucosa, causing spasmodic contraction and ischemia of the smooth muscle. Intestinal mucosal damage can cause digestive dysfunction, causing malnutrition. When the number of insects is large, it often twists into a mass in the intestinal lumen, causing intestinal obstruction. The proximal ileocecal part of the obstruction is common. When the number of insects is small, intestinal obstruction can also occur, and intussusception or intestinal torsion can also be caused. Aphids are prone to smashing, causing various serious complications when stimulated in the intestines. Drilling into the biliary tract, causing biliary ascariasis is particularly common and serious. When aphids invade the cystic duct or intrahepatic bile duct, they may be followed by bacterial infection to cause acute cholangitis, cholecystitis, or acute hemorrhagic necrotizing pancreatitis. It can cause liver abscess when deep into the intrahepatic bile duct. Changes in inflammation or aphids themselves can cause perforation of the gallbladder or biliary tract, causing biliary peritonitis. Aphids that penetrate the biliary tract can sometimes quit or switch direction and return to the small intestine or spit out from the mouth, or even death in the common bile duct. Can also drill into the appendix, surgical wounds, abdominal wall abscess, gastrointestinal decompression tube, T-shaped drainage tube, eustachian tube and other parts, and even into the trachea caused by asphyxia. Even into the brain, spinal canal, nose, kidney, bladder, prostate, urethra, uterus, vagina, etc. caused the corresponding lesions. Aphids ectopically parasitize and ovulate, and if left in some organs (such as liver, lung, pancreas, peritoneum and mesentery), they can form granuloma. If left in the biliary tract or gallbladder, the egg or mites are the core, and stones can be formed gradually.

2. Pathology

(1) Intestinal changes: gas and fluid accumulation in the intestinal lumen of the upper segment of the obstruction, dilatation of the intestinal lumen, enhanced intestinal movement, attempt to overcome obstruction, at this time only the obstruction of the intestinal lumen, no obstacles to blood circulation, simple intestinal obstruction. If it continues to develop, the blood circulation disorder and necrosis of the intestinal wall will turn into purple-black, which is called strangulated intestinal obstruction. When the intestinal lumen is dilated or paralyzed, the mites are stimulated to turbulent in the intestine, such as drilling the weak part of the intestinal wall and causing peritonitis or single-onset abdominal abscess.

(2) Systemic changes: mainly dehydration and hydroelectric disturbances, toxin absorption and infection. For example, the toxins of the bacteria in the intestine penetrate into the abdominal cavity, causing peritonitis to be absorbed into the bloodstream, resulting in systemic poisoning.

an examination

The early stage of aphid intestinal obstruction is mostly partial. It is characterized by paroxysmal abdominal pain, bloating, nausea, vomiting, sometimes spitting or aphid. Abdominal pain is mostly colic. During the examination, the abdominal muscle tension was not obvious. Most patients felt a cord-like or sausage-like mass in the umbilical cord or the right lower abdomen. There was a sense of unevenness or a sense of movement in the acupressure, and the mass could move slightly. Complete obstruction can occur in the advanced stage. Most of the obstruction is located at the end of the ileum.

1. History: The history of mites infection is commonly used in children, such as the history of anal worms or the history of vomiting.

2. Clinical manifestations: paroxysmal abdominal pain and vomiting. Intestinal bloating is not obvious, and there is no obvious muscle tension, but the abdomen can be in the umbilical or right lower abdomen and a cord-like mass. The mass can be deformed, can move, and the surface has high or low unevenness or sensation. The beep can be normal or hyperactive. In the advanced stage, there may be symptoms and signs of complete intestinal obstruction.

3. Auxiliary examination: The shadow of the worms in the intestinal lumen can be seen on the plain X-ray film, so the diagnosis is not difficult.

Differential diagnosis

Differential diagnosis of aphid intestinal tract:

1. Intussusception: A segment of the intestine is inserted into its connected intestinal lumen. It is the most common type of acute intestinal obstruction in infants. Most of the predilections are inserted into the wide cecal cavity from the end of the ileum. The incidence is related to factors such as intestinal caliber, intestinal wall tumor, diverticulum lesion, and intestinal peristalsis. The typical three major symptoms are abdominal pain, jam-like blood and abdominal mass. Mainly manifested as paroxysmal abdominal pain, sick children showed paroxysmal crying, pale, sweating, lower limb flexion of the abdomen, lasting for a few minutes and suddenly quiet. The abdomen can touch the active and tender mass, and the symptoms of intestinal obstruction are obvious. Adults have milder symptoms and fewer blood donors, often with incomplete obstruction. Atypical should be differentiated from appendicitis, tumors and other types of intestinal obstruction. The sputum angiography showed that the end of the sleeve was in the shape of a cup. If the nesting occurred for a long time, the necrosis or perforation of the intestine would be prohibited. A well-diagnosed early intussusception can be used for air enema and abdominal ablation. If it has not been reset for more than 48 hours, surgical reduction should be considered. If the reduction is difficult, local intestinal resection and anastomosis may be feasible. Adult intussusception is caused by some pathological factors, so surgical treatment is generally appropriate. This disease can also occur in the elderly due to long-term constipation.

2, chronic intestinal pseudo-obstruction: chronic intestinal pseudo-obstruction (chronic intestinal pseudo-obstruction) is a syndrome of intestinal obstruction symptoms and signs but no evidence of mechanical obstruction. Paralytic ileus is acute intestinal pseudo-obstruction, as described above. Here is a description of chronic intestinal pseudo-obstruction.

3, adhesive intestinal obstruction: adhesive intestinal obstruction is abdominal surgery, inflammation, extensive intestinal adhesion formed after trauma, acute intestinal obstruction caused by adhesions, is the most common type of intestinal obstruction. Most patients have a history of abdominal surgery, inflammation, trauma or tuberculosis. There are overeating or strenuous exercise incentives before the attack. In the past, there was often abdominal pain or a history of bowel adhesions. A small number of congenital cords in the abdomen are more common in children. Symptoms mainly include paroxysmal abdominal cramps and repeated vomiting, and the sputum is yellow-green liquid, even for fecal juice, touching the bowel type and hearing high sputum bow sounds.

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