Duodenal duplication anomaly

　　First, etiology

　　There are many explanations for the etiology of congenital gastrointestinal duplication anomaly, but there is no satisfactory conclusion and no breakthrough progress. It is generally believed that there are several theories:

　　1, incomplete cavitation:Bremer believes that in the early stage of embryogenesis, due to cell proliferation, the digestive tract becomes a solid phase, and later, longitudinal arranged vesicles are formed in the solid phase intestinal lumen, which fuse to form lumens (cavitation phase). If the cavitation is incomplete, it can form stenosis, atresia, and other malformations. If in this development process, the wandering lumen forms a circular tubular cavity, it is considered a duplication anomaly, adhering to the adjacent intestinal wall. The histological structure of duodenal duplication anomaly is very similar to that of the duodenum.

　　2, non-regression of the diverticulum-shaped outer pouch:Thyng and Lewis found that in the early stage of human embryogenesis and mammals, the digestive tract parts have a diverticulum-shaped outer pouch, the ileum is the most, which is consistent with the fact that duplication anomalies are prone to occur in the ileum. Under normal circumstances, the diverticulum-shaped outer pouch can gradually regress spontaneously.

　　3, others:Such as the theory of embryonic twinning: In 1953, Ravitch believed that rectal and total colonic duplication anomaly, like double penis scrotum, double uterus vagina, double urethra, belong to embryonic twinning anomaly. The theory of spinal cord and primitive gut separation difficulty: In 1952, Veencklass believed that during the formation of the spinal cord in the third week of embryogenesis, the ectoderm and endoderm were adhered together, making it difficult to separate, the intestinal tube and the neural tube were separated abnormally, and diverticulum-like protuberances occurred during the formation of the intestinal tube, which developed into various morphological gastrointestinal duplication anomalies.

　　Second, pathogenesis

　　Duodenal duplication anomaly often located on the inner side of the duodenum, with a spherical or oval shape, most of which are cystic, because they do not communicate with the intestinal lumen, they are also called enterogenous cysts in clinical practice.

　　The intestinal wall of duodenal duplication anomaly is histologically similar to that of the normal duodenal wall, most of which are cystic, with the cyst wall containing serosa, smooth muscle, and mucosa. The mucosa of the cyst wall often has wandering gastric mucosa. It can also cause ulcerative disease, massive upper gastrointestinal bleeding, and inflammatory perforation. Most of the cystic cavities do not communicate, and they can also be supplied by the same small intestinal blood vessels. The distal and proximal ends of the cystic cavity can communicate with the duodenum. The cyst cavity contains colorless mucus, which may become purple-black when bleeding. According to pathology, there are gross morphological types, and clinically, they can be divided into 3 types: diverticulum type, cystic type, and tubular type.

　　Complications of duodenal duplication malformation: the secretion of a large amount of gastric acid by wandering gastric mucosa can erode the cyst wall and duodenal mucosa, causing ulcers. It can also erode large blood vessels under the mucosa, leading to massive hemorrhage in the gastrointestinal tract. Perforation of the intestinal wall or cyst wall can lead to severe peritonitis. The main clinical manifestations are abdominal pain, muscle tension, nausea, vomiting, fever, and in severe cases, hypotension and systemic toxic reactions. If not treated promptly, it can lead to death from toxic shock.

　　Symptoms often occur in infants and may appear during the first feeding. However, there are also cases where it is not discovered until the age of 60.

　　1, Mass in the upper abdomen:Generally, an active mass can be felt in the upper abdomen, and sometimes the mass is discovered before the onset of symptoms. The size varies, mostly round and cystic. Larger ones can even fill the gap between the ribs and iliac crest. There are reports that duodenal duplication malformation can lead to cancer.

　　2, Obstruction symptoms:Due to the expansion of the cystic malformation, it compresses the duodenum, causing complete or incomplete obstruction, and occasionally jaundice.

　　3, Pain:The mucosa within this malformation secretes a large amount of fluid, increasing the intracavitary pressure, which can cause pain.

　　4, Intestinal necrosis:Occasionally, compression of the duodenum can cause bleeding and intestinal necrosis.

　　5, Ulcer bleeding, perforation:It is often due to the secretion of a large amount of gastric acid and digestive enzymes by wandering gastric mucosa in the cavity, which erodes the cyst wall or duodenal wall to form ulcers, and the hematochezia is mostly tarry.

　　Avoid fevers and colds in the early stages of pregnancy.Women who had a high fever during early pregnancy may experience adverse effects on the development of the brain tissue of their child, even if there are no obvious external deformities. This may manifest as intellectual disability, poor learning and response abilities. This intellectual disability is irreversible. Of course, fetal deformities caused by high fever are also related to the sensitivity of pregnant women to high fever and other factors.

　　Avoid close contact with cats and dogs.Few people know that cats carrying bacteria are also a significant source of infectious diseases that can cause fetal deformities, and cat feces are the main route of transmission for these恶性 infectious diseases.

　　Avoid women who wear heavy makeup every day.Surveys show that the incidence of fetal deformities in women who wear heavy makeup every day is 1.25 times higher than in those who do not. The main adverse effects on the development of fetal deformities are caused by toxic substances such as arsenic, lead, and mercury contained in cosmetics, which affect the normal development of the fetus. The second is that some components in cosmetics can produce aromatic amines with teratogenic effects after being exposed to ultraviolet rays from the sun.

　　Avoid emotional stress during pregnancy.Human emotions are controlled by the central nervous system and the endocrine system, and one of the endocrine hormones, adrenal cortical hormone, is closely related to emotional changes in humans. When a pregnant woman is emotionally tense, adrenal cortical hormone may hinder the integration of certain fetal tissues, and if this occurs during the first three months of pregnancy, it may cause fetal cleft lip or cleft palate and other deformities.

　　Avoid drinking alcohol.Drinking alcohol during pregnancy can cause severe damage to the developing fetus as the alcohol can pass through the placenta. This may result in conditions such as a small head, extremely small ears and nose, and a thick upper lip.

　　6, Avoid eating moldy food.Experts have pointed out that if pregnant women consume food contaminated with mold (moldy food), mycotoxins can pass through the placenta to harm the fetus, causing cell chromosome breakage in the fetus.

　　1, X-ray barium meal examination:It can be seen that the duodenum has expansion, deformation due to compression, and high intestinal obstruction, and sometimes a mass shadow can be found.

　　2, Other:Radionuclide 99mTc scan is helpful for gastrointestinal bleeding, and CT examination can also confirm the diagnosis.

　　Avoid drinking alcohol. When pregnant women drink alcohol, alcohol can pass through the placenta to the developing embryo, causing serious damage to the fetus. Such as a small head, extremely small ears and nose, and a thick upper lip, etc. Avoid eating moldy food. Experts have pointed out that if pregnant women consume food contaminated with mold (moldy food), mycotoxins can pass through the placenta to harm the fetus, causing cell chromosome breakage in the fetus.

　　After confirming the duodenal duplication malformation, surgery is the main treatment method. Because the intestine and the duplicated cyst share the same intestinal wall, the operation should be cautious to prevent injury to the duodenal intestinal wall and blood supply.

　　Duodenal duplication malformation is anatomically closely related to the head of the pancreas, the biliary tract system, and the duodenum, and is very easy to damage the common bile duct, pancreas, and important blood vessels, and the operation is difficult, so it is not suitable for resection. The best method is to anastomose the cystic wall of the duplicated intestine with the duodenum (also known as window surgery), which is the classic Gardner-Hart operation.

　　Method: Make a longitudinal incision in the anterior wall of the duplicated cyst, suck out the liquid inside the cyst; expose the interval between the cyst and the duodenum and incise it; trim a part to form an opening window, and suture the edge of the window with silk thread for hemostasis; then trim the excess cyst wall and suture it to close, making the cyst communicate with the duodenal lumen. Generally, there is no need for abdominal drainage. There is also anastomosis between the cystic cavity and the jejunum.

　　Giant duodenal duplication malformation, generally severe condition, with infection in the cystic cavity, emergency surgery can be done by making a bag-shaped suture and external drainage, and consider radical surgery after 2 months.