Gastrointestinal duplication anomalies

　　There are many theories to explain the pathogenic causes of gastrointestinal duplication anomalies.

　　1. The re-piping chemistry theory: During the re-piping phase in early embryogenesis, the internal vesicles fuse together. If some vesicles do not completely fuse with the intestinal cavity, they can develop into duplicated intestines.

　　2. The fetal intestinal diverticulum residue theory: In the early stages of embryonic gastrointestinal tract development, many diverticulum-like external sacs appear, most commonly in the distal part of the small intestine. Normally, diverticula gradually regress and disappear. If they do not regress or have residuals during development, they can develop into cystic duplications.

　　3. The neural tube dysgenesis theory: During the formation of the notochord in the third week of embryogenesis, adhesion occurs between the endoderm and ectoderm, causing difficulties in the separation of the neural tube and intestinal tube. Due to the traction of the endoderm, diverticulum-like protuberances are formed. When the endoderm develops into the intestinal tube, these protuberances develop into various morphological duplications of the gastrointestinal tract.

　　4. The vascular theory: In recent years, many scholars have supported this theory, which holds that ischemic infarction lesions occur after the development of fetal intestinal tract, leading to intestinal atresia, intestinal stenosis, and short small intestine. Necrotic residual intestinal fragments are nourished by nearby blood vessels, and can develop into intestinal duplication anomalies through self-growth. This explanation is also supported by clinical practice, with cases of intestinal duplication accompanied by intestinal atresia or stenosis, and short small intestine.

　　In summary, it is generally believed that the pathogenesis is polygenic, and different畸形 at different locations and morphologies may be caused by different etiologies.

　　In addition to general symptoms, it can also cause other diseases. The duplication畸形 of the digestive tract in this disease can cause complications such as intestinal obstruction, gastrointestinal bleeding, abdominal mass, abdominal pain, and respiratory symptoms. Therefore, once discovered, active treatment is needed, and preventive measures should also be taken in daily life.

　　Due to the different locations, morphologies, volumes, complications, and associated other畸形 of the digestive tract duplication畸形, the clinical symptoms are different, and symptoms can appear at any age, with most cases occurring in infancy.

　　1. Intrathoracic duplication畸形 of the digestive tract can compress the respiratory tract, causing respiratory distress, and compress the esophagus to produce obstruction symptoms. When the cavity is lined with gastric mucosa, the adjacent esophageal and lung tissues can be inflamed due to corrosion by gastric acid and digestive enzymes, even leading to perforation and bleeding, resulting in hematemesis, hematochezia, or empyema.

　　2. Patients with gastric duplication畸形 have a feeling of fullness in the upper abdomen, vomiting without bile, and a cystic mass can be felt below the costal margin in the right upper abdomen.

　　3. In patients with ileal duplication畸形, a large spherical cyst compresses the intestinal tract, causing intestinal obstruction. Circular or elliptical, smooth cystic masses can be felt in the abdomen with certain mobility. An increase in fluid in the cyst cavity causes the cyst wall to become tense, resulting in pain and tenderness. Small spherical cysts in the muscular layer of the intestinal wall often cause intussusception. Some duplication畸形 can cause the attached intestinal segment to twist, leading to intestinal necrosis. Tube-like畸形 that communicate with the intestinal tract, as the fluid in the cavity can be excreted through the intestinal tract, are not easily palpable. When the lining is gastric mucosa, ulcers often occur, leading to hematemesis or hematochezia. Perforation of the ulcer leads to symptoms of peritonitis.
　　4. The clinical symptoms of colonic duplication畸形 are mild, and compression of the intestinal tract can cause symptoms of low intestinal obstruction. Blood in the stool is bright red when accompanied by bleeding, often accompanied by duplication of the ureters, bladder, vagina, urethra, and rectal anal畸形.

　　5. Rectal duplication畸形 appears early with difficulty in defecation, and when a mass protrudes from the rectum during defecation, it is a characteristic of rectal saccular duplication畸形. A cystic mass can be felt behind the rectum during rectal examination.

　　The duplication畸形 of the digestive tract is a disease condition caused by developmental abnormalities, so it is impossible to directly prevent the disease by targeting the cause. Early detection, early diagnosis, and early treatment are of great significance for indirectly preventing the disease, and genetic counseling should also be carried out. Preventive measures include avoiding marriage between close relatives, carrier gene testing, prenatal diagnosis, and selective induced abortion to prevent the birth of affected children. Pay attention to regular B-ultrasound examinations during pregnancy to clarify the situation.

　　The duplication畸形 of the digestive tract can be diagnosed by barium meal examination, B-ultrasound examination, and isotope 99mTc scan.

　　X-ray examination, myelography, MRI or CT examination, abdominal ultrasound examination are of great significance for the diagnosis of cystic malformations.

　　When there is a mass shadow in the right posterior mediastinum on chest X-ray, especially in patients with thoracic vertebral malformations, consider esophageal repeated malformations. When performing barium meal or barium enema examination due to abdominal pain and abdominal mass, circular filling defects in the intestinal cavity or pressure marks on the intestinal wall can be seen. Or barium enters the malformation cystic cavity, which can display the shape and range of the malformation and make a diagnosis. Ultrasound examination can suggest cystic lesions. Fiberoptic endoscopy is also conducive to the diagnosis.

　　Patients with gastrointestinal repeated malformations should pay attention to eating more fresh vegetables and fruits in their diet, appropriately increase the intake of protein and vitamin-rich foods, eat more roughage foods to promote the smooth downward movement of stool, which will reduce the chance of constipation and intestinal obstruction, and avoid eating spicy and刺激性 foods, smoking and drinking.

　　1. Pay attention to avoid staying up late and avoiding fatigue.

　　2. It is advisable to actively treat the symptoms after the onset has affected the body.

　　Due to the complications of gastrointestinal repeated malformations such as respiratory distress, intestinal obstruction, intussusception, gastrointestinal bleeding, perforation, etc., which are life-threatening, it is necessary to perform surgical treatment after the diagnosis is established. During the operation, it is necessary to avoid missing multiple repeated malformations, and the surgical method varies according to the anatomical situation of the malformation:

　　1. Simple repeated malformation resection:It is suitable for esophageal repeated malformations that are not connected with the esophagus and have no adhesions, or a few spherical malformations coming from the posterior peritoneum or hanging on the separated mesentery.

　　2. Excision of repeated intestine and its attached normal intestine:It is suitable for most small intestines, colonic repeated malformations and part of the stomach repeated malformations, because they are usually supplied by the same blood vessel.

　　3. Windowed internal drainage surgery:It is suitable for duodenal repeated malformations, that is, to partially resect the repeated malformations and the adjacent duodenal wall, so that both can communicate with each other, which is simple and easy to perform, and the effect is satisfactory.

　　4. Partial septum resection:It is suitable for tubular repeated malformations and part of the stomach repeated to change the double cavity into a single cavity, which is conducive to the smooth excretion of intestinal cavity contents.