Duodenal stasis

　　There are many causes of duodenal stasis, among which the compression of the superior mesenteric artery on the duodenum forming stasis is the most common, which is also called superior mesenteric artery syndrome. Other causes include:

　　One, congenital abnormalities such as congenital peritoneal bands that compress and pull to block the duodenum, congenital narrowing or occlusion of the distal duodenum, compression of the descending segment of the duodenum by annular pancreas, macro-duodenum produced by duodenal hypoplasia, and the duodenum hanging severely due to congenital variation, which can fold the duodenojejunal angle and close it, thus causing stasis.

　　One, tumors such as benign and malignant tumors of the duodenum, retroperitoneal tumors such as kidney tumors, pancreatic cancer, lymphoma, metastatic cancer of the duodenum, adjacent enlarged lymph nodes, mesenteric cysts, or compression of the duodenum by abdominal aortic aneurysm.

　　Three, distant or proximal jejunal infiltrative diseases and inflammation of the duodenum; such as progressive systemic sclerosis, Crohn's disease, and inflammatory adhesions or compression causing narrowing, etc.

　　Four, adhesions and traction of the duodenum after cholecystectomy and gastrectomy, adhesions, ulcers, stenosis, or input loop syndrome after gastrojejunal anastomosis.

　　Five, other congenital malformations such as duodenal inversion, duodenal-jejunal colonic bands caused by cholecystojejunal adhesions, and atypical portal vein, and abnormal position of the Vaterian ampulla.

　　Duodenal stasis is prone to complications such as intestinal obstruction, and long-term vomiting can lead to disorders of water and electrolyte metabolism.

　　One, intestinal obstruction refers to the obstruction of intestinal contents in the intestines. It is a common acute abdominal disease, which can be caused by various factors. At the beginning of the onset, the obstructed intestinal segment first has anatomical and functional changes, followed by the loss of body fluids and electrolytes, intestinal wall circulation disorders, necrosis, and secondary infection. Finally, it can lead to sepsis, shock, and death.

　　Water and electrolytes are widely distributed inside and outside the cells, participating in many important functions and metabolic activities in the body, and play a very important role in maintaining normal life activities. The dynamic balance of water and electrolytes in the body is achieved through the regulation of the nervous and humoral systems. Common disorders of water and electrolyte metabolism in clinical practice include hyperosmotic dehydration, hyponatremic dehydration, isosmotic dehydration, edema, water intoxication, hypokalemia, and hyperkalemia.

　　Duodenal stasis refers to a clinical syndrome caused by duodenal obstruction due to various reasons, leading to dilation of the proximal part of the duodenum and retention of chyme. The diagnosis of duodenal stasis is made through endoscopy, X-ray barium meal examination, superior mesenteric artery angiography, retrograde cholangiopancreatography, and other methods. Common symptoms include:

　　One, Upper Abdominal Pain

　　Pain and distension in the upper abdomen that is uncomfortable is the main feature of this disease. Sometimes it can be manifested as periumbilical pain, which can radiate to the upper right abdomen, below the xiphoid process, or the back, usually appearing or worsening 1-4 hours after meals, with intermittent attacks. Sometimes the patient may present with acute severe pain, similar to biliary colic. Some patients may have abdominal pain similar to duodenal ulcer, presenting regular pain before meals or at night. Also, some patients may only feel mild discomfort in the upper abdomen, which can be significantly reduced or relieved when changing position, such as assuming a prone or knee-chest position.

　　Two, Vomiting

　　Vomiting is also a major symptom of this disease. Due to the weakness of the spleen and stomach, the food is not digested, and the retained food accumulates, causing the stagnation of Qi, Dampness, and Food, leading to the obstruction of the gastrointestinal tract, hence vomiting after eating is often the earliest symptom to appear. The time of vomiting occurs immediately after meals, and some may occur several hours after meals, with the vomit being the food eaten or food残渣 retained in the stomach with bile.

　　Three, Other Symptoms

　　In addition to the above symptoms, most patients may have symptoms such as belching, acid regurgitation, nausea, loss of appetite, indigestion, abdominal distension, and even symptoms such as hematemesis and melena. If long-term repeated attacks occur, it can eventually lead to malnutrition, resulting in body thinning or anemia. Some patients may cause electrolyte imbalance and acid-base imbalance due to frequent vomiting, even presenting with cachexia.

　　Four, Signs

　　During an attack of symptoms, there may be distension and tenderness in the upper abdomen, marked tenderness along the duodenum, compression of the lower abdomen causing the mesentery to rise, or having the patient assume a prone or chest-knee position, which can alleviate pain. Sometimes, there may also be visible gastric configuration or peristaltic waves.

　　Duodenal stasis refers to duodenal obstruction caused by various reasons, and preventing the primary disease is the main task. It is advisable to eat in small portions and more frequently, perform knee-chest position for half an hour after meals, and strengthen abdominal muscle exercises. Tumors such as benign and malignant tumors of the duodenum, retroperitoneal tumors such as kidney tumors, pancreatic cancer, lymphoma, metastatic cancer of the duodenum, enlarged lymph nodes near the duodenum, mesenteric cysts, or abdominal aortic aneurysms compressing the duodenum.

　　The examination required for patients with duodenal stasis includes the following:

　　First, laboratory examination

　　Gastric juice examination can detect bile. After fasting for 16 hours, the retained overnight food residue in the duodenal juice can still be detected. If there are desquamated epithelial cells, mucus, and a large number of bacteria in the duodenal juice, it may be complicated with duodenitis. In addition, about fifty percent of patients may have mild or moderate anemia.

　　Second, X-ray examination

　　The typical X-ray manifestation of this disease is that when standing for examination, barium through the horizontal segment of the duodenum is blocked, and the intestinal tube above the blockage is significantly dilated. The dilated intestinal tube shows strong forward and backward peristalsis, forming the so-called 'pendulum-like movement'. At the site of compression in the horizontal part of the duodenum, there is a smooth and regular longitudinal indentation. When the patient takes a prone position, the reversible peristalsis is often reversed, and the barium reaches the jejunum smoothly. The mucosal folds of the duodenum are normal or only have local mucosal thickening.

　　Patients with duodenal stasis syndrome should try to eat easily digestible foods, and pay attention to avoiding postoperative adhesions after abdominal surgery.

　　Eat easily digestible foods such as congee, noodles, steamed buns, flower rolls, dumplings, soft cakes, soft rice, etc., chew slowly and thoroughly, which is convenient for full digestion and absorption.

　　Eat less legumes, onions, potatoes, sweet potatoes, and other foods that are easy to produce acid and gas. Avoid cold and greasy foods, spicy foods, and alcohol to avoid adverse factors stimulating ulcers.

　　Especially recommend the yam lotus lily congee, peanut red bean millet porridge for nourishing the stomach and invigorating the spleen. You can add eggs, minced meat, chicken puree, fish puree, chopped vegetables, fruit granules, milk, and other seasonings to increase nutrition.

　　When the condition of duodenal stasis syndrome recurs repeatedly, and the effect of multiple comprehensive medical treatments is not good, surgical treatment can be performed. At present, there are three commonly used surgical methods:

　　1. Treiz ligament release surgery.

　　2. Duodenal jejunal anastomosis.

　　3. Gastric jejunal anastomosis.

　　It is currently recognized that duodenal-jejunal anastomosis is the most effective surgical method. Its operation position is superficial, easy to expose, and convenient and quick during anastomosis. The anastomotic effect is reliable, and there is no need to worry about the surgery affecting the duodenal papilla, and the chance of anastomotic fistula is relatively low. It will not affect the digestive and absorptive function of the gastrointestinal tract and avoids the occurrence of intestinal blind loops, reducing the incidence of postoperative complications.