Intestinal atresia

Introduction Intestinal atresia refers to the development of intestinal ducts during the embryonic stage. During the re-tubing process, part of the intestines terminates and the intestinal lumen is completely or partially blocked. Complete blockage is occlusion and partial blockage is stenosis. It can occur in any part of the intestine, but it is most common in the ileum, followed by the duodenum, and the colon is rare. It is one of the common causes of intestinal obstruction in newborns. Congenital intestinal atresia and intestinal stenosis are prominent manifestations of vomiting. Frequent vomiting occurs in a few hours to 1-2 days after birth. In most cases, vomit contains bile, and in a few cases, vomit is old blood.

Cause

1 In the embryonic development stage, the intestine cavitation in the solid phase can produce intestinal atresia or stenosis.

2 fetal blood vessels in the bowel, such as fetal intestine torsion, intussusception, fetal fecal peritonitis and adhesions of intestinal narrowing, intestinal perforation, internal hemorrhoids, mesenteric vascular developmental malformation caused by a part of the bowel blood supply disorders, Intestinal atresia is formed by causing pathological physiological processes such as necrosis, absorption, and repair of the intestine. Seven cases of intestinal atresia have been seen, and the intussusception in the intestine of the specimen has been changed. The cases of intestinal atresia with intra-abdominal adhesion and scattered calcification have been seen many times. Congenital intestinal atresia is most common in the lower jejunum and ileum, followed by the duodenum, and colonic atresia is rare. Intestinal stenosis is most common in the duodenum and less in the ileum. There are two pathological forms of intestinal atresia: one is membrane-type atresia, and there is a diaphragm in the intestine that blocks the intestinal cavity to form a lock, which is more common in the duodenum and jejunum, and its appearance still maintains its continuity.

Another type of intestinal tube loses its continuity, or only one fiber cord is connected, and the intestinal tube at both ends of the obstruction is blind end, which is more common in the lower end of the jejunum and the ileum. Single occlusion is more common, and there are also multiple occlusions accounting for 7.5% to 20%. The proximal tubule of the atresia is dilated due to long-term obstruction, and the diameter can reach 3 to 5 cm. The intestinal wall is hypertrophy, and local anemia, necrosis and perforation can also occur. The distal intestine has a small contracture diameter of 4 to 6 mm, no gas in the cavity, and only a small amount of mucus and exfoliated cells. If intestinal atresia occurs after the formation of the fetus, a small amount of black-green fetus can be seen at the distal end of the lock.

an examination

Related inspection

Gastrointestinal CT examination of gastrointestinal diseases by ultrasound examination of gastrointestinal imaging

Congenital intestinal atresia and intestinal stenosis are prominent manifestations of vomiting. Frequent vomiting occurs in a few hours to 1-2 days after birth. In most cases, vomit contains bile, and in a few cases, vomit is old blood. No normal meconium is discharged. Or just discharge a small amount of gray-green jelly. High intestinal atresia or stenosis is generally no bloating, only the upper abdomen is slightly full; low intestinal atresia or stenosis is obvious bloating, and even the intestinal type is visible. Severe vomiting can cause dehydration, acid-base imbalance, and electrolyte imbalance. X-ray abdominal plain film, high atresia or severe stenosis can be seen in the stomach and duodenum with 2 to 3 liquid levels, while the jejunum is not inflated; low locus or severe stenosis can be seen in most enlarged intestinal curvature and fluid level.

Differential diagnosis

Newborns begin to have persistent vomiting after birth, no normal meconium discharge or progressive abdominal distension, that is, the possibility of intestinal atresia should be suspected. Such as anal finger test and warm saline or 1% hydrogen peroxide solution enema still do not discharge normal fetus, can further exclude fecal constipation and congenital megacolon. In the past, the Farber test was used to check the non-keratinized epithelial cells and fetal hair in meconium to diagnose intestinal atresia. It has diagnostic value for the formation of intestinal atresia within 3 months, but it is caused by mechanical or vascularity in the middle and late fetuses. Intestinal atresia is not diagnostic. Abdominal X-ray plain film has great value in diagnosis. High intestinal incision standing position X can be seen in the upper abdomen of 2 to 3 enlarged liquid level, other intestines are not inflated at all, and low intestinal obstruction can be seen to enlarge the intestinal curvature and liquid level. The barium enema can be seen in a small contracted fetal colon, the characteristics of the fetal colon: 1 diameter is about 0.5cm; 2 the colonic bag-like folds are not obvious; 3 the colon is straight and short, and the result of the barium enema can exclude the congenital megacolon and Poor intestinal rotation.

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