Effect of duodenal stasis on the body
When comparing the data of neurohistological examination of intramural ganglia of the duodenum with the duration of clinical symptoms and anatomical changes on the side of the intestinal wall, a certain relationship can be noted: the longer the gastric history and the more frequent the exacerbation of the process, the more pronounced the defeat of the intramural nerve apparatus of the Auerbach's plexusmore resistant were the anatomical changes in the wall of the duodenum in the form of its ectasia and atony.
In the pathogenesis of changes in the intramural nervous apparatus of the duodenum, the leading importance is attached to pathological impulses, which come primarily from the mucous membrane of the intestine and stomach, as well as from the biliary tract and pancreas.
Symptomatics and course of the disease in patients with violation of patency of the duodenum, both in the independent version of the flow, and in cases when duodenal stasis is a concomitant condition or develops after surgery, indicate an exceptional variability of clinical manifestations, ranging from minimal symptoms to a picture of total obstructionduodenum. A feature of the course of chronic impairment of duodenal permeability, along with paroxysmal, is the tendency towards progressive deterioration and gradual involvement of organs operatively associated with the duodenum( stomach, biliary tract, pancreas) in the painful process.
Regardless of whether duodenal stasis is an independent or concomitant disease or it develops after surgery, it can be the cause of various complications both from the side of the wall of the gut( duodenitis) and from the organs associated with it( gastritis, and sometimes ulcer,cholecystitis, pancreatitis).
Thus, it turns out as if a vicious circle. Inflammatory changes of this or that organ are the cause first of functional disorders of the motility of the duodenum, and then the stance of its ectasia and atony. With the development of such changes in the intestine, the latter adversely affect the function of the organs associated with the duodenum and cause inflammatory changes in them.
Diagnosis of duodenal stasis is based on a comprehensive study of the patient, taking into account complaints, history, clinical manifestations of the disease, objective research, radiographic data, hydrostatic pressure, duodenal kinesiography, and additional methods: cholecystocholangiography, aortosenterography, fibroduodenoscopy. Occasionally, duodenal stasis can be recognized only during surgery, when revising the horseshoe of the duodenum.
In an integrated treatment of patients with violation of patency of the duodenum, an important place is taken by conservative treatment.
The operation is indicated for the mechanical nature of duodenal stasis, as well as for persistent impairment of the patency of the duodenum of any nature, which is accompanied by its ectasia.
During the operation, a thorough revision of not only the horseshoe of the duodenum, but also the stomach, biliary tract, pancreas and small intestine loops( to exclude another primary organic disease that led to duodenal stasis) is necessary before deciding on operational tactics. A more effective operation is the implementation of the y-shaped anastomosis between the actively peristaltic part of the jejunum and the atonic duodenum. This operation is supplemented by anastomosis with the gall bladder( in its own modification).
When duodenal stasis is combined with organic disease of the stomach or duodenum, resection of the stomach according to Bilrot II and application of duodenojunoanastomosis is shown.
In conclusion, it should be noted that, despite the fact that the duodenal stasis has now received more attention, until recently many doctors in the diagnosis and treatment of patients with various diseases of the abdominal cavity do not always take into account the state of motor-evacuation function of the duodenum. This is often the reason for the erroneous diagnosis and wrong treatment of patients.
The aim of this work is to attract the attention of physicians to this section of pathology, especially to the issues of necessary research in patients with gastric duodenal gastrointestinal complaints, as well as to the questions of choosing the right tactics for treating patients and preventing possible complications associated with impaired motor function of the duodenum.
Read more Duodenosis, treatment of