Small bowel expansion

Introduction Intestinal dilatation: an important manifestation of malabsorption syndrome, more common in the jejunum, especially in the lower and middle parts of the jejunum, sometimes causing expansion of the entire small intestine including the duodenum. The extent of small bowel expansion is related to the severity of the disease, and the cause of the expansion is low tension in the small intestine. Some people think that if the small intestine diameter is larger than 31mm, it can be considered as expansion. When the expansion is obvious, the intestinal diameter can be 2~3 times normal. Intestinal inflating can be light and heavy, and colon inflation is mostly significant, often manifested as a peritoneal colonic balloon. The small intestine is distributed in the middle abdomen within the colon frame. When the expansion is heavy, the intestinal fistula is continuous in a tubular shape; when the expansion is light, it is a divided inflatable intestine.

Cause

1. Mechanical stimulation during abdominal operation: During the operation, the patient's peristaltic function is temporarily lost due to the stimulation of the intestine and its mesentery, or there is an uncoordinated peristalsis in the intestinal wall, but no intestinal contents are pushed. At the time of rhythm, the patient often has abdominal flatulence after surgery, and sometimes abdominal pain. Generally, the rhythm of intestinal peristalsis returns to normal after 2 to 3 days after surgery, and the intestinal gas and fluid can be smoothly discharged from the body, and the abdominal distension and abdominal pain also disappear.

2. Inflammation in the abdominal cavity: peritonitis caused by various causes, especially diffuse peritonitis, often occurs in intestinal paralysis and even abdominal distension.

3. Neuroreflexive stimulation: Reflex intestinal palsy can occur after a variety of strangling pains, such as renal colic, biliary colic, colic with retinal torsion, ovarian cyst torsion and spermatic cord strangulation.

4. Chest and abdomen or spinal nerve injury: can cause intestinal effusion and abdominal expansion.

5. Post-peritoneal lesions such as bleeding and tumors can also cause varying degrees of intestinal paralysis.

6. Mesenteric lesions: such as mesenteric vascular occlusion, tumor, torsion, etc. can cause intestinal paralysis due to nerve impulse conduction to the intestinal wall.

7. Others: such as long-term ether anesthesia, over-extended plaster vest fixation, and infections in other parts of the abdomen such as pneumonia, meningitis or various sepsis can occasionally cause reflex intestinal paralysis.

an examination

Related inspection

Oral small bowel angiography small intestine angiography small intestine filling and emptying function check

According to the clinical manifestations of the medical history, combined with X-ray, CT and other examinations and diagnosis, it is clear that when the X-ray film is examined, there is often a phenomenon of inflation and expansion of all intestinal fistulas, and there are multiple liquid levels in the intestinal lumen. However, in a few cases, only a few intestinal fistulas have localized intestinal paralysis. This image should be distinguished from mechanical ileus and strangulated intestinal obstruction.

Differential diagnosis

Intestinal damage: The small intestine occupies the largest position in the abdominal cavity, has a wide distribution, is relatively superficial, and lacks bone protection. In the open injury, the small intestine injury rate accounts for 25% to 30%, and the closed injury accounts for 15% to 20%. When any injury to the abdomen needs to be explored, the examination of the small intestine should be performed carefully, carefully, and regularly.

Intestinal bacterial overgrowth: The elderly have a poor malabsorption syndrome, which is mainly related to the degenerative changes of the digestive system in the elderly. When people reach old age, the small intestine villi becomes shorter, the absorption area decreases, the pancreas gradually shrinks, and the interstitial fibrous connective tissue proliferates. These changes cause the intestinal bacteria to overgrow, the digestive tract diverticulitis and diverticulosis are significantly increased, and the degenerative changes cause heat. Insufficient intake and malnutrition can contribute to or aggravate malabsorption syndrome. Low intestinal obstruction: a clinical manifestation of intestinal obstruction. Intestinal obstruction (ileus) refers to the intestinal contents being blocked in the intestine. High intestinal obstruction frequently vomits and bloating is mild, low intestinal obstruction is reversed, the clinical manifestations of colonic obstruction are similar to low intestinal obstruction, but X-ray abdominal plain film examination can distinguish small intestinal obstruction is inflatable intestinal fistula throughout the whole abdominal fluid level More, while the colon does not show, if it is colonic obstruction, the expansion of the colon around the abdomen and the accumulation of gas in the pocket-shaped small intestine is not obvious.

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