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Inborn impassability of a duodenum - Diseases of digestive organs at children

Table of contents
Diseases of digestive organs at children
Oral cavity
Diseases of teeth
Malformations of the sky and soft tissues of an oral cavity
Diseases of a mucous membrane of an oral cavity and gums
Diseases of lips and language
Digestive tract
Basic reasons of gastrointestinal frustration
Atresia and esophageal and tracheal fistula
Guttural and tracheal and esophageal crevice, inborn stenosis of a gullet
Other diseases of a gullet
Stomach and intestines
Peptic ulcer
Inborn hypertrophic pyloric stenosis
Inborn impassability of intestines
Inborn impassability of a duodenum
Disturbances of turn of intestines
Inborn impassability of a small bowel
Inborn megacolon
Diverticulums and duplikatura
The acquired impassability of intestines
Intestines invagination
Foreign bodys of a stomach and intestines
Motive frustration. stomach and intestines
Anomalies of a structure of anorectal area
Infectious diseases of intestines
Nonspecific ulcer colitis
Illness Krone
Necrotic coloenteritis of newborns
The coloenteritis connected with treatment by antibiotics
Gastrointestinal symptoms of anaphylactoid purpura, gemolitiko-uraemic syndrome
Intolerance of food proteins
Eosinophilic gastroenteritis
Absorption disturbance syndromes
Immunodeficiency and intestines
Syndrome of "a congestive loop"
Syndrome of a short small bowel
Gee's disease
Sprue after acute enteritis
Tropical to a spr
Whipple's illness, intestines lymphangiectasia, Uolmap's illness, idiopathic diffusion defeat of mucous
Enzymopathies and disturbances of mechanisms of transport of nutrients
Irritable colon
Acute appendicitis
Diseases of an anus, direct and large intestine
Tumors of a digestive tract at children
Hernias of a digestive tract at children
Exocrine part of a pancreas
Embryonic development of structure and function of a liver
Diagnosis of diseases of a liver
Cholestatic states at babies
Parenchymatous jaundices at children of chest age
Disturbances of a metabolism of a liver and zhelchevydelitelny system
Anomalies of a structure of bilious ways
Cysts of bilious channels
Cholestasia and diseases of a liver connected with completely parenteral food
Medicinal damage of a liver
Ray's syndrome
Chronic hepatitis
Wilson's illness — Konovalova
Indian juvenile cirrhosis
Damages of a liver at chronic colitis
Cirrhosis and chronic liver failure
Portal hypertensia and varicosity of a gullet
Fatty infiltration of a liver
Peritoneum diseases
Peritoneum hernias

Etiology. It is considered that the gut gleam vacuolation delay during the embryonal period leads to formation of a membrane from a mucous membrane in a duodenum or to its atresia. The atresia can also develop owing to vascular pathology.
Pathogeny. The Atrezirovanny duodenum comes to an end blindly at once behind a big duodenal nipple. In 20 — 30% of cases this pathology is combined with a Down syndrome; in 20% of cases the general bilious channel opens in distal part of a gut below an atresia site. Occasionally, especially at diafragmopodobny type of an atresia, bile comes to intestines, both distalny, and proksimalny impassability zones. The second reason of impassability of a duodenum — incomplete turn of a middle part of intestines at which the caecum is located before duodenal and squeezes it. Serious complication of a malrotation of intestines is gut torsion at newborns; this pathology demands acceptance of urgent measures. The ring-shaped pancreas clasping the descending part of a duodenum can squeeze it, causing partial or full obstruction. This anomaly is almost always combined with an inborn stenosis of a duodenum. The connective tissue membrane of a duodenum can be observed at the wrong turn of an intestinal tube. In rare instances the portal vein is located before a duodenum bulb, squeezing it and causing impassability.
Clinical manifestations. Vomiting can begin the weight painted by bile right after the birth or after a while (especially at partial obstruction). In epigastric area it is possible to observe peristaltic waves, but the stomach is not always increased. As it was stated above, at such children symptoms of a Down syndrome are possible, and their mothers have a pregnancy abounding in water. Repeated vomitings lead to development of a metabolic alkalosis, sharply expressed dehydration and disturbance of water-salt balance. If the zone of an atresia is localized proksimalny a big duodenal nipple, then emetic masses is not painted by bile. Except an atresia, there are also other reasons of impassability, but they prove later, after achievement of monthly age by the child. So, the patient with a stenosis of a duodenum feels well within several months, and at the chronic duodenal impassability which is combined with the wrong turn of intestines, clinical manifestations develop still later.
Diagnosis. The diagnosis is made on the basis of the X-ray inspection conducted at vertical and horizontal position of the patient. In typical cases on the roentgenogram removed at vertical position of the patient "the double bubble" owing to accumulation of air in upper part of a stomach and the stretched duodenum is visible; besides, the horizontal line on border of liquid and gas (fig. 12-12) is defined. At a full atresia in distal part of a digestive tract gas, naturally, is not visible. The same radiological signs are observed also at other listed above forms of duodenal impassability. If impassability of a duodenum radiological is diagnosed, then it is necessary to carry out urgently an irrigoskopiya to exclude pathological rotation of intestines. At not omission of a caecum the reason of impassability it is necessary to consider a duodenum prelum as the peritoneal tyazha of Ladd fixing a caecum.
Treatment. At an atresia and a stenosis of a duodenum surgically create a bypass anastomosis, carrying out a duodenoduodenostomiya or a duodenojejunostomy. If impassability arises owing to Ladd's syndrome, then the patient should be operated. After a section of abnormal folds and a tyazhy peritoneum all large intestine is fixed in the left half of an abdominal cavity, and a small bowel — in right, i.e. recreate a fetalis arrangement of intestines before rotation. The best way of treatment of a ring-shaped pancreas — a duodenoduodenostomiya without gland section; at the same time the nonfunctioning piece of a gut is done as it is possible well. In the presence of a diaphragm of a duodenum it is reasonable to carry out a duodenoplasty.

Fig. 12-12. The survey roentgenogram of the newborn made in vertical position of the patient. Gas bubbles in upper part of an abdominal cavity and lack of gas in distal department of intestines testify to a duodenum atresia.
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