Bipartite stomach

　　1. Etiology

　　The etiology is not yet clear and may be related to the following factors.

　　1. Theory of incomplete cavitation:At 6 weeks of embryonic development, the growth rate of the digestive tract is faster than that of the entire embryo. The rapid growth of the length of the digestive tract is first dependent on the proliferation of epithelial cells inside the cavity, resulting in the narrowing or occlusion of certain parts of the cavity, forming solid cord-like bodies. Normally, the liquid secreted by the epithelial cells accumulates between cells to form bubbles. These bubbles are arranged along the longitudinal axis of the digestive tract, then fuse with each other or communicate with the main cavity. When all the epithelial cells are stretched and covered on the surface of the growing digestive tract, all the bubbles eventually completely fill the cavity, completing the growth of the digestive tract. If a group of cells fuse with each other but do not communicate with the digestive tract during the cavitation period, a cystic malformation is formed. Bipartite stomach is also formed by incomplete cavitation.

　　2. Theory of adhesion between ectoderm and endoderm:McLetchie proposed that the occurrence of digestive tract malformations is related to developmental disorders at 3 weeks of embryonic development, with abnormal adhesion between the endoderm and ectoderm. At that time, it was the stage of notochord formation, where the notochord first split into two segments, and the endoderm and ectoderm adhere through the intersegmental canal. In this way, the spinal cord and vertebra pass through the dermis and digestive tract to form the neural-intestinal tube. In the subsequent development process, the neural-intestinal tube forms various different duplications through differentiation, complete retention, or retention of a part.

　　2. Pathogenesis

　　In gross morphology, bipartite stomach appears as cysts of various shapes and sizes, with small ones only a few centimeters in diameter, and large ones can repeat the entire stomach, even extending to the esophagus and duodenum.

　　Bipartite stomach commonly occurs in the area near the pylorus on the greater curvature of the stomach. Most of them are not connected to the gastric cavity and present as cystic types, sharing a common wall and communication tube with the stomach. The inner mucosa is mostly gastric mucosa, with a few being mucosa of adjacent digestive tract. There may be ectopic pancreatic tissue around it, and sometimes there are tubes communicating with the ectopic pancreatic ducts, even the ectopic pancreatic ducts can be connected separately with the bipartite stomach and the normal pancreatic ducts. The cystic type of bipartite stomach increases in size due to the continuous increase of secretions inside the cavity, causing compression of the stomach and incomplete pyloric obstruction. The gastric mucosa of bipartite stomach can produce hydrochloric acid, leading to peptic ulcers.

　　The occurrence of peptic ulcers is even rarer. If ulcers occur, vomiting, hematochezia, upper abdominal pain may appear, and occasionally perforation may occur.

　　1. Peptic ulcers mainly refer to chronic ulcers occurring in the stomach and duodenum, which are common diseases. The formation of ulcers has various factors, among which the digestive action of acidic gastric juice on the mucosa is the basic factor for ulcer formation, hence the name. Any part that comes into contact with acidic gastric juice, such as the lower esophagus, the anastomosis after gastrojejunal anastomosis, jejunum, and Meckel diverticulum with ectopic gastric mucosa, the vast majority of ulcers occur in the duodenum and stomach, hence also known as gastric and duodenal ulcers.

　　1. Blood is excreted from the anus, feces contain blood, or are entirely bloodstained, with colors ranging from bright red, dark red, or tarry, all of which are called hematochezia. Hematochezia is generally seen in lower gastrointestinal bleeding, especially bleeding from the colon and rectum, but occasionally upper gastrointestinal bleeding can be seen. The color of hematochezia depends on the location of the gastrointestinal bleeding, the amount of bleeding, and the time the blood stays in the intestine.

　　Symptoms and signs are not obvious, and symptoms often appear within one year after birth. They are related to the size and location of the cyst, whether it communicates with the gastric cavity, and whether there is ectopic mucosa. About 1/3 of the cases have the main symptom of vomiting, and can also have symptoms such as upper abdominal pain, hematochezia, constipation, and no weight gain. The only sign is that a cystic mass can be palpated in the upper abdomen. Double stomach can also cause high intestinal obstruction, resulting in abdominal distension, upper abdominal tenderness, anemia, and dehydration. The occurrence of obstruction is less than that of the duodenum, and the occurrence of peptic ulcers is even rarer. If ulcers occur, vomiting, hematochezia, upper abdominal pain may appear, and occasionally perforation may occur.

　　Pregnant women with polyhydramnios should be alert to the possibility of congenital malformations. Elevated amniocentesis and amniotic fluid alpha-fetoprotein, acetylcholinesterase levels can help with prenatal diagnosis. (Amniotic fluid volume increases daily from early pregnancy and begins to decrease in the last 4 weeks. The amount of amniotic fluid in a full-term pregnancy is about 1000 to 1500 ml. In any stage of pregnancy, if the amniotic fluid volume exceeds 2000 ml, it is called polyhydramnios. A slow increase in amniotic fluid volume is called chronic polyhydramnios, and a sharp increase in amniotic fluid volume over a short period of time is called acute polyhydramnios. Polyhydramnios is more common in patients with fetal malformations, twins, diabetes, and incompatibility of maternal and fetal blood types. The appearance and properties of amniotic fluid are no different from normal when polyhydramnios occurs).

　　1. X-ray barium meal examination

　　The great curvature of the stomach shows indentation or a circular mass protruding into the gastric cavity, causing the pylorus to deform and narrow. In a very few cases, a double stomach that communicates with the gastric cavity can be seen where barium meal flows into the double gastric cavity.

　　2. Abdominal Wall Ultrasound Examination

　　Cystic masses in the upper abdomen can be found, and the diagnosis is more accurate through endoscopic ultrasound examination. It can clearly distinguish the various layers of the stomach wall and the cysts attached to the outer layer of the stomach, and even new growths inside the double stomach can be found.

　　3. Gastroscopy

　　Cystic masses protruding into the antrum or pylorus of the stomach can be found, in addition, CT and MRI examinations can also be performed. For patients with recurrent pancreatitis, the most feasible examination method to distinguish whether there is an ectopic pancreas and whether the duct of the ectopic pancreas communicates with the double stomach is retrograde cholangiopancreatography.

　　1. Start with lifestyle, make sure to have three meals a day at fixed times and quantities, and it's best to set a schedule for yourself and strictly adhere to it. This will also affect sleep time, as some people who stay up late eat breakfast and lunch together. This habit must be changed.

　　2. People with poor stomach digestion have symptoms such as feeling full after eating a little, and bloating after eating a little more. Especially eating more at night can affect sleep due to stomach distension. Hard and fibrous foods are not easy to digest. Therefore, it is recommended to eat small and frequent meals. If it's not time for the main meal, you can supplement some food, but not too much. Remember, this is not a main meal; regular meals should still be eaten as usual.

　　3. Foods should be soft and loose, and it is not advisable to eat too much of things that are tough and crispy, as these are the hardest to digest.

　　4. Soup is best drunk before meals, not after meals as it can increase the difficulty of digestion. It is best not to eat anything two or three hours before going to bed, otherwise, it may affect sleep. If you feel hungry, you can drink more water.

　　5. People with stomach diseases should quit smoking, drink less or no alcohol, coffee, strong tea, or carbonated drinks.

　　6. Although soy milk is good, it is cold in nature and cannot replace milk.

　　7. Bread can nourish the stomach, so why not try it as a staple food.

　　After the diagnosis of double stomach is clear, timely surgical treatment should be carried out. The usual method is to remove the double stomach and the common stomach wall, and then perform gastric wall anastomosis. This method is practical and reliable with few complications. In addition, partial gastrectomy can also be performed. For cases with ectopic pancreas, double stomach, and even communication with the normal pancreatic duct, the ectopic pancreas should be removed, and its passage should be cut off near the normal pancreas to prevent the recurrence of pancreatitis.