Intestinal congestion

Introduction Duodenal stasis refers to the duodenal obstruction caused by various causes, resulting in the proximal end of the duodenal obstruction and the clinical syndrome caused by chyme accumulation. Such as congenital peritoneal ligament compression to block the duodenum; congenital stenosis or occlusion of the duodenum distal, annular pancreatic compression of the duodenum descending; duodenal dysplasia The duodenum, as well as the duodenum, are severely sag due to congenital variation, and the duodenal jejunum can be folded to close it, resulting in hoarding.

Cause

There are many causes of this disease. Most of the mesenteric artery is compressed by the mesenteric artery to form a hoarding (50%). This condition is also called superior mesenteric artery syndrome. Other reasons are:

1 congenital anomalies: such as congenital peritoneal band compression to block the duodenum; duodenal distal congenital stenosis or occlusion, annular pancreas compression duodenum descending; duodenal dysplasia The resulting giant duodenum, as well as the duodenum, are severely sag due to congenital variation, and can be closed by duplication of the duodenal jejunum horn, resulting in hoarding.

2 tumors: benign and malignant tumors of the duodenum; retroperitoneal tumors such as kidney tumors, pancreatic cancer, lymphoma; metastatic carcinoma of the duodenum, adjacent enlarged lymph nodes (carcinoma metastasis), mesenteric cysts or abdominal aortic aneurysms Press the duodenum.

3 Duodenal distal or proximal jejunal invasive disease and inflammation: such as progressive systemic sclerosis, Crohn's disease, and diverticulitis caused by diverticulitis or compression.

4 Gallbladder and gastric surgery after adhesion to pull the duodenum: adhesion, ulcer, stenosis or sputum syndrome after gastrojejunostomy.

5 other congenital malformations: duodenal inversion, duodenal obstruction caused by gallbladder duodenal colon cord; duodenal anterior portal vein; abnormal position of Fauter's ampulla (opening of common bile duct in twelve Refers to the third part of the intestine).

The transverse section of the duodenum is located posterior to the retroperitoneum, spanning from the right to the left across the third lumbar vertebrae and the abdominal aorta, with the anterior superior mesenteric vascular bundle in the mesenteric root. If the angle between the two is too small, the duodenum can be compressed. The superior mesenteric artery is generally divided at the level of the first lumbar vertebrae and is at an angle of 30° to 42° to the aorta.

In addition, the following five factors are also the cause of mechanical obstruction:

1 The superior mesenteric artery is too long and too short;

2 superior mesenteric artery variation;

3 abnormally large veins in front of the duodenum;

4 lordosis of the spine reduces the space occupied by the duodenum;

5 The length of the intestine of the elongated or visceral sag draws the mesenteric root.

an examination

1 typical symptoms are an important basis for diagnosis.

2X line barium meal examination features: the horizontal part of the duodenum sees the break of the column (sudden vertical cut); the pendulum movement consisting of strong forward peristalsis and reverse peristalsis in the proximal segment of the intestine; the expectorant passes smoothly in the prone position, and the peristalsis disappear.

3 Selective superior mesenteric artery angiography if necessary, showing the anatomical relationship with the duodenum.

Differential diagnosis

Identification of chronic duodenal stagnation caused by other causes

Duodenal tumors such as pancreatic head cancer or giant pancreatic cyst compression can cause duodenal stagnation, which can be distinguished by endoscopy or retrograde cholangiopancreatography and B-ultrasound and CT. Occasionally, the disease is caused by the abdominal aortic aneurysm pressing the duodenum. In addition, it is also necessary to distinguish from duodenal obstruction caused by stones in the duodenum, hairy feces, mites, and foreign bodies.

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