What Is Gastric Outlet Obstruction?
Congenital gastric outlet obstruction refers to pyloric sinus or pyloric obstruction, and the incidence rate is 1% of congenital gastrointestinal atresia. Can be divided into 4 types: pyloric sinus rupture atresia, pyloric rupture atresia, pyloric membrane atresia or stenosis, pyloric sinus membrane atresia or stenosis.
Basic Information
- Visiting department
- General Surgery
- Multiple groups
- premature baby
- Common locations
- stomach
- Common symptoms
- Vomiting, abdominal distension, difficulty in defecation
Causes of congenital gastric outlet obstruction
- At present, the etiology of the disease is not clear. It is speculated that the development of the endoderm canal was interrupted before the 8th week of the embryo, resulting in a fracture atresia. After 8 weeks, the endoderm formed a diaphragm that was connected after too long.
Clinical manifestations of congenital gastric outlet obstruction
- This disease is more common in premature infants. Most children have a history of excessive amniotic fluid. Diaphragm holes are large enough to be asymptomatic through food. Small diaphragm holes or secondary inflammation cause mucosal edema and narrow holes can cause symptoms of obstruction. Shortly after birth. Vomiting, vomiting immediately after feeding, spraying, with milk and milk clots, no bile and blood, vomiting is intermittent with loss of appetite and weight loss, generally 10% to 15% below the standard weight. Even lower than 25% to 40%, crying, irritability after eating, relieved after vomiting, vomiting stubbornness can appear dehydration, alkalosis, malnutrition, physical examination of the upper abdomen, swelling of the stomach, may have stomach shape with gastric peristaltic waves, middle and lower abdomen When the diaphragm is nonporous (completely closed), the symptoms of high obstruction occur earlier. If the diaphragm is two, the lower part of the stomach and the upper part of the duodenum swell, filled with secretions, forming a cystic mass. The abdomen is palpable.
Congenital gastric outlet obstruction
- 1. X-ray inspection
- The plain radiograph of the abdomen only shows that there is a wide fluid level in the left upper abdomen, and there is no gas in other parts of the abdomen, which supports the diagnosis of pyloric atresia.
- Barium meal gastrointestinal examination shows that the stomach is dilated to varying degrees, the barium is retained, the barium is discharged slowly, and the valve is typically characterized by a small amount of barium entering the pylorus or duodenal bulb, and the funnel-shaped narrowing of the pyloric duct is thin, but does not extend. No curvature; or a thin diaphragm protruded perpendicular to the longitudinal axis of the pylorus into the gastric antrum at a distance of 1 to 2 cm from the proximal end of the pylorus; older children's valve thickness was less than 2 to 4 mm, and the distal end of the stenosis was separated from the proximal pylorus to " Double ball sign. "
- 2. Fiber gastroscopy
- It can be seen that there is a crescent-shaped mucosal fold in the distal part of the gastric antrum, sometimes there is a small hole in the center, and the pylorus cannot be seen through the hole. Sometimes, the gastroscope can not only diagnose the disease, but also remove the diaphragm to treat the disease.
Diagnosis of congenital gastric outlet obstruction
- Diagnosis is mainly confirmed by X-ray examination, barium meal of the upper gastrointestinal tract, gastroscopy or surgery. Those with unknown diagnosis and stubborn vomiting and epigastric swelling need to be confirmed by surgical exploration.
Differential diagnosis of congenital gastric outlet obstruction
- It should be distinguished from duodenal atresia, pyloric spasm, congenital hypertrophic pyloric stenosis, gastric mucosal prolapse, duodenal atresia or stenosis.
Treatment of congenital gastric outlet obstruction
- No matter what type of pyloric atresia and stenosis should be treated surgically, blind-end atresia should be performed gastroduodenal end-to-end or end-to-side anastomosis, which meets the physiological anatomic effect of pyloric or pyloric sinus valve atresia or stenosis. Perform valvectomy for pyloroplasty. During the operation, a porous gastrointestinal decompression tube is sent to the duodenum. In the neonatal period, due to edema and hypertrophy of the small pyloric lumen, it is difficult to remove the valve. Surgery can also get good results.
- Conservative treatment is only applicable to patients with pyloric valve stenosis confirmed by X-ray examination or endoscopy, without obvious obstruction symptoms.
- Resection of the diaphragm is performed surgically. If the edema of the diaphragm is obstructed, gastrointestinal anastomosis is required. Nutritional support should be taken before and after surgery. Dehydration and hypochloric alkalosis should be corrected. Patients with continuous vomiting need gastrointestinal decompression.
Prognosis of congenital gastric outlet obstruction
- The prognosis is good, some children completely return to normal after 1 to 2 months of treatment, and their growth and development are good.