November
10
11:45
Children // Child health

Congenital esophageal stenosis in children


Neznachitelnyesuzheniya esophagus is clinically recognized and found by chance navskrytii children who died from various causes.Especially difficult are stenozyvyyavit young children.

Prichinoyvrozhdennyh esophageal stenosis is a violation of vacuolization primary kishechnoytrubki, whereby there is a thickening of all layers of the esophagus (gipertrofiyamyshechnogo layer, the appearance of the mucous membranes, abnormally developed blood vessels it.d.).

Morfologicheskirazlichayut several types of congenital narrowing of the esophagus: circular, hypertrophic, membranous (due to thickening of atypical raspolozhennoyslizistoy shell).Circular type arises from the inclusion of stenkupischevoda during the embryonic formation of the fibrous or cartilaginous rings, hypertrophic - formed by the hypertrophy of the muscle layer of the esophagus opredelennogouchastka, membranous - due to the formation of the mucous membranes, which narrows the lumen of the esophagus.The latest style shell type gastric, whic

h because of its thickness protrudes into the lumen of the esophagus.

Vrozhdennyystenoz esophagus often localized in the middle or lower part of his rezhevstrechaetsya in the upper third.

Clinical symptoms

Klinicheskiesimptomy due to the degree of narrowing of the esophagus, its morphology and the age of the patient.Prineznachitelnom narrowing in infants receiving semi-liquid and zhidkuyupischu, the symptoms are mild, they often do not notice.In stark vyrazhennomstenoze observed the same phenomenon as in Artesia esophagus.With perevodomrebenka more dense food, the symptoms become more distinct.

Klassicheskimisimptomami are constant dysphagia and regurgitation during or immediately posleedy.In 33% of cases of esophageal stenosis in children of the first three months zhizninablyudayutsya respiratory distress during feeding, vomiting and regurgitation.Child lured becomes restless, throws back his head.In children older than shestimesyatsev time there hypersalivation.Vomit izneizmennoy consist of food, mucus and saliva without the sour smell of gastric soderzhimogo.Srygivaniya increasing age are becoming more frequent and constant, because the force of the muscle layer above suzheniyasohranena and is to some extent offset the difficulty of passing pischicherez narrowed portion of the esophagus.After some time, muscle strength is exhausted, decompensation occurs, which leads to a continuous and postoyannomusrygivaniyu.The walls of the esophagus above the stenosis lose elasticity, dilatiruyutsya forming sacciform extension.Advanced prestenotichesky site pischevodaokazyvaet compression effect on the trachea, leading to dyspnea, stridor, cyanosis, coughing fits.Prestenoticheskomrasshirenii stagnate in food can be aspirated and give rise to aspiratsionnyypnevmonii.Moreover, stagnant food undergoes bakterialnomurazlozheniyu;from the mouth of an unpleasant, rotten smell.

may bytsluchai of acute obstruction of the esophagus that occurs vrezultate "Welding of" thick pieces of food in the stenotic uchastokpischevoda.

Tsirkulyarnyei membrane options esophageal stenosis are not accompanied by vomiting.Narrowing, localized in the abdominal part of the esophagus, manifested in later periods razvitiyarebenka (not earlier than 6 months of age), as a rule, dysphagia, and then idrugie above symptoms.Because of the common symptoms described anomaliirazvitiya esophagus should be noted lag in physical development, malnutrition, hypokinesia (patients try to move less), anemia.

Klinicheskiydiagnoz must be confirmed by X-ray to establish the nature of the change localization stenozai esophageal mucosa.Before rentgenokontrastnymissledovaniem patient's esophagus washed to remove food debris and slizi.Predpochtitelnee X-ray examination carried out in a patient with a tight gorizontalnompolozhenii filling of the esophagus.Research provoditsyadlitelnoe - until the arrival of contrast agent in the stomach and oporozhneniyapischevoda.On the X-ray clearly shows narrowing of the esophagus.

Reshayuscheediagnosticheskoe importance endoscopy of the esophagus.Ezofagofibroskopiyu provodyats preliminary application relaxants.

Treatment

Treatment vbolshinstve cases promptly.With a small degree of stenosis with lechenienachinayut bougienage elastic buzhami administered through the mouth.In posledneevremya began to apply special dilators.During treatment buzhirovaniembolnoy should receive liquid and semi-liquid food.If three courses lecheniyabuzhirovaniem not given effect, produce surgery.

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