Ileal anomalies

　　There are many theories about the etiology of small intestinal duplication anomalies, but each theory cannot fully explain the cause of duplication anomalies at various sites. The etiology may be multifactorial, and the etiology may differ at different sites and with different pathological changes.

　　1. The theory of primitive gut cavitation disorders

　　After the fifth week of embryonic development, the rapid proliferation of epithelial cells in the primitive gut cavity causes a temporary obstruction of the cavity. Later, the epithelial cells in the obstructed gut cavity develop many vacuoles, reconnecting the obstructed cavity, which is known as the cavitation phase. If developmental disorders occur at this time, the interloop of the intestinal tract may form a parallel interval to the digestive tract, possibly leading to intestinal cystic duplication anomalies.

　　2. The theory of diverticulum-like external pouch

　　At 8-9 weeks of embryonic development, the distal part of the small intestine forms a temporary diverticulum-like external pouch due to the outward proliferation of epithelial cells covered by connective tissue. This pouch gradually disappears later. If it remains, the diverticulum-like external pouch at the original site can develop into a cystic type of small intestinal duplication anomaly.

　　3. The theory of notochord-primitive gut separation disorder

　　At 3 weeks of embryonic development, the notochord forms between the inner and outer germ layers. If there is abnormal adhesion between the inner and outer germ layers at this time, the notochord is divided into two parts, left and right, at that site. The notochord and vertebral bodies form a cord-like enteric nerve tube between the outer germ layer and the digestive tract. When the inner germ layer develops into the intestinal tract later, the intestinal tract at the site pulled by the cord-like adhesion bulges to the dorsal side to form a diverticulum-like bulge, which can develop into a duplication anomaly in the future. Since the adhesions all occur on the dorsal side of the primitive gut, the duplication anomalies are also located on the mesenteric side. The cord-like adhesions can affect the development of the vertebrae, so this type of duplication anomaly often occurs with vertebral development anomalies, such as hemivertebrae and butterfly vertebrae. Li Long et al. divided intestinal duplication anomalies into two types, and the mesenteric type duplication anomaly is exactly located between the two mesenteries, accounting for 91.6%. It is associated with thoracic vertebral deformities and proposed that this type is caused by the separation disorder between the notochord and the primitive gut.

　　4. The theory of ischemic necrosis of the primitive gut

　　In recent years, many scholars have studied and believed that after the completion of enteric development, due to ischemic necrotic lesions in the primitive gut, changes such as intestinal atresia, stenosis, and short small intestine occur. The remaining intestinal fragments after necrosis receive blood supply from nearby vessels and can develop into duplication anomalies by themselves. Therefore, some children with small intestinal duplication anomalies may also have intestinal atresia, stenosis, and short small intestine and other anomalies.

　　Some children with small intestinal duplication anomalies may also have other anomalies such as intestinal atresia, stenosis, and short small intestine.

　　As the extraintestinal cyst gradually increases in size, it compresses the intestines causing obstruction, and can also be induced by gravity to cause intestinal torsion, leading to severe abdominal colic, vomiting, cessation of defecation and flatus, and even the appearance of bloody watery stools, fever, thin pulse, shock, and other symptoms of poisoning.

　　Small intestinal duplication anomalies can coexist with small intestinal atresia, malrotation of the intestines, and umbilical hernia. Sometimes, duplication anomalies are found during emergency laparotomy for coexisting anomalies. Chest and abdominal duplication anomalies often occur with hemivertebrae or fused deformities of the neck and thoracic vertebrae. There are not many cases of intestinal duplication anomalies presenting with abdominal masses, and children with malnutrition are more prone to palpate active masses due to weak abdominal walls.

　　Symptoms can appear at any age, with 60% to 83% of cases occurring within 2 years of age, and many cases show symptoms within one month of birth. A few cases are asymptomatic and are discovered only during laparotomy for other diseases. General symptoms include pain in the abdomen of unknown cause, hematochezia, incomplete or complete intestinal obstruction, and especially when a cystic mass is palpated in the abdomen, one should consider small intestinal duplication anomaly. Abdominal X-ray films show uniform density cystic shadows, or small intestinal barium filling defects, compression, barium filling of tubular or diverticular shape outside the small intestinal tract, and spinal deformities, all of which have diagnostic value.

　　The clinical symptoms of small intestinal duplication anomaly vary greatly due to complex factors such as pathophysiological characteristics, location, pathological morphology, size, whether it is connected with the intestinal tract, and whether there are complications. Symptoms can appear at any age, 60% to 83% of which occur within 2 years of age, and many cases show symptoms within one month of birth. A few cases are asymptomatic and are found only when abdominal surgery is performed for other diseases. Therefore, if children under 2 years of age have unexplained abdominal pain, hematochezia, incomplete or complete intestinal obstruction, especially when a cystic mass is palpated in the abdomen, ileal duplication anomaly should be considered. Early detection, diagnosis, and treatment can prevent and control the development and changes of the disease.

　　1. X-ray examination:Abdominal plain film can show compression and displacement of the intestinal tract, and incomplete intestinal obstruction cases show arc-shaped pressure marks in the intestinal tract in gastrointestinal fluoroscopy. Barium meal examination can show a filling defect or compression of a certain group of small intestine barium, especially attention should be paid to the imaging of the terminal ileum and ileocecal valve area. If there is a barium-filled tubular or diverticular image outside the small intestine and there is peristalsis, it has important diagnostic value.

　　X-ray film of the spine shows abnormal vertebral bodies, and further myelography, magnetic resonance imaging, or CT examination should be performed to determine whether there is a neural tube cyst in the spinal canal.

　　2. Ultrasound examination:Abdominal ultrasound shows abdominal mass as cystic, and makes a judgment on its location and size, which is conducive to diagnosis and differential diagnosis.

　　3. Radioisotope examination:When there is ectopic gastric mucosa in the duplicated intestinal tract, after intravenous injection of 99mTc and abdominal scanning, it is often possible to show a radioactive concentration area at the location of the duplicated intestinal tract, but it needs to be distinguished from Meckel's diverticulum, and it should be noted that a negative result cannot negate the diagnosis.

　　4. Laparoscopic examination:If laparoscopic examination is possible, it can accurately determine the location and type of the lesion.

　　Principles of dietary adjustment

　　1. From less to more.

　　2. From thin to thick.

　　3. From simple to diverse.

　　Summarized into eight characters, it is 'progressive and frequent, less and more'. The specific method is to start with drinking a small amount of boiled water at first, and if there is no special discomfort, you can change to liquid foods such as vegetable soup, fish soup, egg soup, congee without residue, and non-fibrous fruit juice, starting with 20-30 milliliters per meal and gradually increasing to 200-300 milliliters. Everyone's progress is different, and meals should be taken to the extent of comfort. Eat 5-6 times a day. In this way, after 1-3 days, change to low-residue semi-liquid diet, such as thin congee, paste, steamed egg paste, and various vegetable purees, with half a bowl to a bowl each time, 3-4 times a day, and some liquid foods can be added between meals. Generally, it can be transitioned to soft food such as porridge, bread, biscuits, apples, bananas, oranges, etc., 3-4 times a day, and about a month after surgery, it can gradually transition to normal diet.

　　If an artificial anus is created, with the peristalsis of the intestines, intestinal fluid flows out to the artificial anus from time to time, and excessive fecal water will also corrode the skin around the artificial anus, causing eczema, bringing a lot of trouble to the patient. Therefore, patients who have an artificial anus should transition from liquid diet to normal diet as soon as possible to reduce the amount of excrement and alleviate the patient's pain. Generally, after 1-2 days of liquid diet after surgery, it can be changed to low-fiber semi-liquid diet, and then quickly transition to eating bread, steamed buns, biscuits, and other foods, while eating more fresh fruits and vegetables, keeping the stool formed and soft, which can reduce its irritation to the skin and is also convenient for the patient to take care of themselves.

　　After the patient recovers and returns to work, there is little difference in the diet at this stage compared to ordinary people. However, it is necessary to remind one point, try to let the food stay in the mouth for a longer time and chew more, which can reduce the burden on the intestines and is conducive to the digestion and absorption of food.

　　Finally, it must be emphasized that there are two taboos in diet adjustment after intestinal surgery: one is to avoid overeating, and the other is to avoid eating unrefrigerated food. Otherwise, it will increase the burden on the intestines, which is not conducive to healing and functional recovery.

　　Surgery is the only treatment method, about 80% of cases are operated due to acute abdomen. Symptomless small intestinal repeated malformations should also be surgically removed to prevent complications and the occurrence of cancer later in life.

　　1. Repeated malformation cyst resection: Some small intestinal repeated malformations have separate mesentery and vascular branches, and the cyst can be completely resected.

　　2. Repeated malformation and main intestinal tract resection anastomosis: Repeated malformations sharing nutritional vessels and muscular walls with the main intestinal tract and repeated malformations within the intestinal wall are difficult to be resected alone.

　　3. Repeated malformation mucosal stripping surgery: A wide range of repeated malformations affecting most of the small intestine, mucosal stripping of the malformed intestinal tract alone will lead to short bowel syndrome in patients who have had intestinal resection.