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Possible causes of an enlarged bowel loop in the fetus. Dilation of the colon in children. Surgery for the formation of bowel loops

Pregnancy forces the body to rebuild, work with stress, you need to provide everything necessary for the mother and the full development of the baby. A growing uterus during pregnancy and a change in the amount of progesterone can also cause pain in the intestines. The intestines hurt for various reasons. It can be colitis or dysbiosis. Observing the correct diet, eating foods rich in fiber, drinking a sufficient amount of fluids, you can significantly alleviate the condition.

It happens that pregnancy causes intestinal obstruction, causing acute pain, as if menstruation begins, there is vomiting, hemodynamic disorders begin to appear, and peritonitis develops. In order not to lead to such critical conditions, from the very beginning of the onset of pregnancy and until a successful outcome, you should follow the doctor's recommendations, follow a diet, monitor the state of the intestines, and the pregnancy will pass without complications.

Intestines during pregnancy

The period of pregnancy is stressful for the body. Rapid changes are taking place in it, now the body is responsible for the life of two creatures. The child grows, the uterus grows, the mutual arrangement of organs begins to change. Another problem that makes the gut worse at work is that pregnancy contributes to the flaccidity of the walls. There is a danger of the appearance of hemorrhoids. To improve blood circulation in the large intestine, you need to try to reduce the pressure that the uterus produces on the veins. It is better to sleep on the left side, try not to stand or sit for a long time.

Almost half of pregnant women have intestinal pain, and the level of bifidobacteria decreases. This also affects the microflora of a bearing child. Proper nutrition, eating foods rich in bifidobacteria, vegetable and fruit juices will help get rid of this problem. Good bowel health will also be inherited by the newborn.

Bowel upset during pregnancy

During pregnancy, a fairly large percentage of women are faced with problems with disorders in the digestive tract. Most often, bowel problems occur in the early stages, when pregnancy has not yet become apparent. Unexplained constipation or diarrhea worries women.

Constipation usually occurs due to changes in progesterone levels. An increase in the hormone content weakens the smooth muscles of the intestines, slows down the movement of food. In addition, the growing fetus begins to squeeze the intestines, disrupting the natural process of digestion. The use of laxatives should be supervised by a doctor so as not to harm the course of pregnancy.

Often, the normal quantity and quality of the intestinal microflora is disrupted and the reason for this is pregnancy. Often there is bloating, belching, an unpleasant taste in the mouth. The course of treatment includes diet, protobiotics, which stimulate the growth of the necessary beneficial bacteria.

Hyperechoic intestine in the fetus

The intestine is called hyperechoic when its echogenicity becomes comparable to the echogenicity of bones. This phenomenon is quite rare. It occurs in the second trimester in about 1% of pregnant women. The appearance of such an intestine should be alerted. This may be due to infection, developmental pathologies. Increased hyperechogenicity of the intestine of the fetus is attributed to reduced peristalsis and water content in meconium.

This phenomenon is often observed with an abnormal karyotype, when the activity of enzymes in the amniotic fluid decreases. Practice has shown that in 46% of pregnant women, the revealed hyperechogenicity of the intestines of the fetus indicates congenital Down syndrome.

It is not uncommon for the appearance of this symptom to indicate intrauterine infection. These are acute forms of cytomegalovirus infection, acute toxoplasmosis, syphilis, rubella. In all these cases, it is recommended to terminate the pregnancy.

However, in 20% of the detected hyperechoic intestines, the problem is resolved on its own in the third trimester, and the child is born without any pathologies, with normal development and weight.

Fetal intestines

The development of the fetus is under the constant attention of the doctor. In cases where ultrasound detects abnormalities, congenital malformations of the gastrointestinal tract should be examined. Developmental changes can be detected in the second trimester. Changes in the echogenicity of the intestine of the fetus are sometimes transient, but may also indicate chromosomal pathologies, including Down's syndrome.

In these cases, medicine recommends an examination. It is necessary to check the analyzes of hormones, alpha-fetoprotein, if there is a suspicion of fetal pathology, amniocentesis should be performed - a procedure for obtaining amniotic fluid, for further research in the laboratory.

Megacolon is a significant expansion of any segment of the large intestine, sigmoid or rectum, which is clinically characterized by chronic constipation, increased abdominal size and developmental delay. The disease can be due to various reasons. In view of the fact that the choice of the correct treatment depends on the precisely established diagnosis, it is necessary to dwell on the individual forms of this pathology.

Aganglionic or congenital enlargement of the colon(Hirschsprung disease)

Etiology and pathological anatomy... In the rectum, sometimes in part of the sigmoid colon, ganglionic cells of the nerve plexus of the intestinal wall are not developed. The aganglionic segment of the intestine is not able to peristalize normally, a narrowing is formed, while the oral segment of the intestine is hypertrophied and gradually expands. Consequently, the pathological section of the intestine is not enlarged,
as it was thought earlier on the basis of anatomical data, but on the contrary, the narrowed part of the intestine. Thus, the basis of severe and chronic disease is the congenital absence of ganglionic cells in the intestinal wall, which is accompanied by the development of narrowing.

The clinical picture. The frequency of such cases is one in 1000 - 2000 newborns. Interestingly, the disease is more common among boys, the cause of which is unknown. Symptoms Late and insignificant excretion of meconium, starting only after the introduction of the gas outlet tube, vomiting, volvulus may appear soon after birth. In the following months, persistent constipation occurs, which sometimes intensifies to intestinal obstruction, after enemas, a large amount of feces is released. The abdomen increases more and more, developmental delay, anemia sets in. A particular danger is intestinal volvulus, injury to the intestinal wall with dense feces, which may be accompanied by bleeding, even perforation, is also possible.

On rectal examination, passing the probe through the empty rectum and narrowing site often causes a large amount of gas and stool to pass. Applying the appropriate technique of filling the rectum with a contrasting mass, it is possible to reveal the narrowing and the expanded section of the intestine located above it.

Treatment . In mild cases, an attempt is made to induce a bowel movement (stool). We recommend malt extract, paraffin oil, acetylcholine derivatives, and if this does not help, high enemas every 2-3 days. Since the introduction of a large amount of water into the dilated intestine can cause poisoning, isotonic sodium chloride solution and paraffin oil are used. In extreme cases, you have to resort to surgery. However, with the above methods, it is necessary to strive to maintain the condition of the child until the moment of the operation and, if possible, ensure regular discharge of feces up to one and a half years of age. The purpose of the operation is to remove a segment of the intestine that does not contain ganglion cells. The results of rectosigmoidectomy are very good, the operation is not associated with great risk. In case of intestinal obstruction in a healthy area, a colostomy is performed and, at a suitable time, a radical operation is performed as the second stage.

Non-aganglionic, secondary enlargement of the large intestine due to narrowing of the anus and rectum

The appearance of this form is explained very simply: the accumulations of fecal masses, which were not detected during the operation, located above the dilated narrowing, expand the proximal segment of the intestine. It is possible to differentiate from aganglionic megacolon on the basis of anamnesis, radiological data and digital examination. In the anatomical non-aganglionic form, in most cases, narrowing of the anus and the initial segment of the rectum is revealed, the ampulla of the rectum is filled with feces.

Atonic, functional, or idiopathic colon enlargement

While in the above two forms, the enlargement of the large intestine joins the anatomical constriction, in this clinical picture there is no evidence of particular narrowing. With the exception of an enlarged rectum, no anatomical abnormalities are observed, constipation is considered functional or neurogenic in origin, and, in essence, the disease manifests itself as a more severe form of functional constipation, which are described below. This disease is more common than Hirschsprung's disease.

Clinical signs... Diseases manifest themselves in preschool children. Usually, parents go to the doctor with complaints that the child has chronic constipation, often accompanied by a special form of fecal incontinence: the child, despite constipation, secretes a small amount of feces into bed. The accumulating fecal masses are retained in the rectal ampulla and, overfilling it, cause fecal incontinence. A digital examination reveals hard feces that fills the entire ampoule of the rectum. The characteristic difference from aganglionic expansion of the large intestine is late manifestation, in the absence of pronounced bloating; with a digital and X-ray examination, an expansion is found that is located immediately above the anus: therefore, we are talking about an expansion not of the sigmoid, but of the rectum.

With aganglionic expansion of the large intestine, the ampulla of the rectum is free, and in this disease it is filled with feces.

Treatment is only therapeutic. Paraffin oil, molasses and, if necessary, are prescribed, especially in the treatment of the disease in the first weeks, enemas. Prostigmine or dihydroergotamine will often give good results. A very important element is education, psychotherapy, and often a good result is given by a change in the environment. Considering the above, from the point of view of further effective treatment within a few weeks, hospitalization is highly advisable.
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Pathologies of the digestive system are often found in the fetus both independently and in combination with other anomalies of internal organs. They account for up to 21% of malformations in newborns and 34% of infant mortality cases.

Causes of violations of the formation of the digestive tract in the fetus, statistics

Anomalies in the structure of the digestive tract are associated with impaired embryogenesis at the stage of 4-8 weeks of pregnancy, when the opening of the digestive tube is being formed. Initially, it ends at both ends, but by the end of the 8th week, channels are formed, and the mucous epithelium closes the lumen of the intestinal tube.

Among the most common pathologies, stenosis (narrowing or stretching of the walls) or atresia (fusion) can be distinguished.

The duodenal ulcer suffers most of all, which is associated with the peculiarities of its embryogenesis. 1/2 of cases is accompanied by defects of other internal organs - heart, blood vessels, rectum, liver, stomach. Some cases are so severe that the baby will have to do many operations during his lifetime, and they will not be the guarantor of his normal existence.

Abnormalities of the gastrointestinal tract on ultrasound are visible at 11 weeks. Ultrasound diagnostics is not a 100% guarantee that the baby will have serious abnormalities, therefore, its results are the basis for a more detailed examination of the woman.

Pregnant women are doing karyotyping to detect chromosomal abnormalities. She also undergoes an analysis of the amniotic fluid, and according to the results of the examination (if they are bad and the diagnosis is confirmed), she is recommended to terminate the pregnancy

Bowel pathology

Duodenal anomalies include:

Atresia.Occurs in 1 case out of 10,000. It consists in complete intestinal obstruction due to pathological fusion of the walls of the organ. In 37% of cases, it is accompanied by other anomalies - equine foot, fusion of the cervical vertebrae, asymmetrical position of the ribs, etc.

In another 2% of cases, intestinal atresia is accompanied by atresia of the esophagus, hygroma of the anus, incomplete rotation of the stomach, etc. This is mainly typical for a fetus with chromosomal abnormalities, in particular with trisomy on chromosome 21.

90% of pregnancies end in miscarriage or developmental fading during the first 2 trimesters. The remaining 10% of pregnancies with duodenal pathology end in the birth of children suffering from various defects: 31% have airway obstruction (blockage by a foreign body such as a cyst, tumor), 24% - paresis of the facial nerve (impaired functionality of facial muscles).

Only 1% of babies lead a relatively normal life after a complex operation, provided that there are no chromosomal abnormalities.

Intra-intestinal membrane... This is a film that overlaps the intestinal lumen, resulting from a violation of the growth of the inner layer of the duodenum. Occurs in 1 case out of 40,000. On ultrasound it is visualized as a weakly echogenic formation. At the same time, the intestinal lumen is narrowed by several millimeters, the contours of the mucous membrane are clear.

Pathology is not an indication for termination of pregnancy. Depending on the location of the membrane, it is removed after the birth of the baby by the duodenotomy method (opening the intestinal lumen with subsequent removal of the membrane).

Malrotation.It consists in a violation of the normal rotation and fixation of the duodenum. If the midgut has made a full turn on the blood-burning pedicle, this can lead to the cessation of blood supply and the death of the midgut.

Prenatal diagnosis can be made from 24 weeks, and in 61.5% of pregnancies polyhydramnios was observed. Ultrasound reveals an anechoic double-buble 3 consequence of enlargement of the intestine and stomach.

Although even a slight extension on a period of 16-22 weeks should be alarming. Normally, the duodenum is visible on ultrasound only from 24 weeks. Additionally, in 62% of cases, fetal malformations of the heart, genitourinary system, and other organs of the gastrointestinal tract are detected. After testing for the karyotype, chromosomal abnormalities are detected in 67% of cases, of which Down's syndrome is in 1st place.

Stenosis.It is detected in 30% of newborns, mainly in boys. This is a partial obstruction of the duodenum, localized in one place. It is mainly observed in the upper sections and is accompanied by anomalies of the pancreas. On ultrasound, it is clearly visible for a period of 24 weeks when using the Doppler method in the study of intestinal blood flow.

Stenosis is successfully resolved and has a more favorable outlook than atresia. Does not require termination of pregnancy.

Megaduodenum... This is an increase in the size of the duodenum to a size that sometimes exceeds the size of the stomach. Occurs in 1 case out of 7500. May be a consequence of the annular pancreas, when the head of the organ wraps around the intestine, or atresia or stenosis of the duodenum. Ultrasound is diagnosed at 24 weeks. The upper part of the abdomen is very swollen, while the lower part is sunken.

Intestinal hyperechogenicity.The higher the density of the tissue being examined, the more echogenicity will be. On ultrasound, the echogenicity of the intestine of the fetus should be lower than the echogenicity of the bones, but higher than that of such porous organs as the liver, lungs or kidneys. When the echogenicity of the intestine is equal in density to the echogenicity of the bone tissue, they speak of hyperechogenicity.

Pathology is detected no earlier than 16 weeks. It indicates a deviation in the development of the fetus. Increased echogenicity occurs with premature aging of the placenta, internal infections, inconsistency between the size of the fetus and the gestational age, endocrine disease, cystic fibrosis, intestinal obstruction (stenosis).

An ultrasound scan should be performed in several different clinics in order to avoid specialist errors. Only with the final confirmation of the diagnosis, the woman is sent for a more detailed examination - biochemical screening, analysis for TORCH infections, cordocentesis and analysis of amniotic fluid. The final diagnosis is made on the basis of a comprehensive analysis, and not just an ultrasound examination.

Diverticula (cysts).They have different names - duplication cysts, double bowel, enterogenic diverticulum. It consists in budding from the walls of the intestine of education in the embryonic period. Formed not only in the intestines, but also throughout the digestive tract from the larynx to the anus.

It is believed that the cause of the bifurcation of the walls is a violation of the blood supply to the digestive tube of the fetus. Cysts on ultrasound are hypoechoic, they are both single-chamber and multi-chamber. The walls of the cysts are two-layered and have increased peristalsis, are hyperechoic if they contain blood.

Intestinal cysts are visualized in the 2nd trimester and are often combined with other pathologies. The accuracy of visualization of intestinal cysts in the fetus is 66.6%. This pathology is not an indication for termination of pregnancy, because in uncomplicated cases, it is operated on and eliminated.

Anomaly in the shape, size, position and mobility of the intestine. By the 2nd trimester of pregnancy, it should turn around the mesenteric artery counterclockwise at 2700. In violation of embryogenesis, the following pathologies can be distinguished: no turn, failed turn and incomplete turn.

On ultrasound, with anomalies of bowel rotation in the fetus, polyhydramnios and expansion of intestinal loops without peristalsis are noted. In the case of intestinal perforation, myconium peritonitis occurs - infection due to the release of intestinal contents. Pathology is detected late, only in the 3rd trimester, which requires immediate preparation of the woman for delivery.

Liver pathology in the fetus

The liver is visualized on ultrasound examination already at the 1st screening. At a period of 11-14 weeks, a hypoechoic formation in the form of a month can be seen in the upper abdominal cavity. By the 25th week, the echogenicity increases and becomes the same as in the intestines, and before childbirth it exceeds the density of the intestines.

It is very important to assess the state of blood flow to the liver. The umbilical cord vein of the fetus enters the liver; in the 2nd trimester, the portal vein is visualized. Its diameter is normally 2-3 mm, and by childbirth it increases to 10-11 mm. The bile ducts should not normally be visualized in the fetus.

One of the most common fetal pathologies - hepatomegaly of the liver - an increase in the size of the organ. To detect the anomaly, a 3D sensor is used that can visualize a slice in longitudinal, transverse and vertical slices. You can also see an increase in the size of the liver and on a conventional ultrasound machine on the protruding tummy, the coverage of which significantly exceeds the norm.

At the same time, various hyperechoic inclusions are visible on the screen. As a rule, the anomaly is complemented by an enlargement of the spleen.

Among the reasons leading to an increase in the size of the digestive organs, there are latent infections (toxoplasmosis, syphilis, chickenpox), as well as chromosomal mutations (Down, Zellweger, Bekwet-Wiedemann syndromes).

  • With Zellweger's syndrome, limb abnormalities, chest distortion, and kidney cysts are visible. Analysis of amniotic fluid reveals a lack of dihydroxy acetone phosphate acyl transferase.
  • Chickenpox, herpes, cytomegalovirus cause calcification of hepatic vein thrombi, which is reflected on the ultrasound screen of the monitor by hyperechoic round calcifications. They are also formed with meconium peritonitis - poisoning by the contents of the intestine of the fetus, which enters as a result of damage to the walls.

In 87.5% of cases, intrauterine infections are the cause of enlargement of the liver and the formation of calcifications. Also, most pregnant women are diagnosed with a hyperechoic intestine, a change in the structure of the placenta, as well as the large size of the spleen. Pathology in the 3rd trimester occurs in the case of a Rh-conflict between a mother and a child.

Also metabolic disorders are not excluded. Enlargement of the liver occurs in galactosemia (a genetic disorder of carbohydrate metabolism, due to which galactose is not converted into glucose), trypsinemia (lack of production of the digestive hormone trypsin), methylmalonic acidemia (absence of conversion of D-methylmalonic acid into succinic acid), disorders of urea excretion.

Single hyperechoic inclusions of a large size are much better than multiple scattered formations in combination with other pathologies. In almost 100% of cases, large hyperechoic inclusions are eliminated before the baby is born or in the first year of life.

In some cases, the malformation of the abdominal organs is misplaced. This happens if the baby's abdominal cavity is compressed by the walls of the uterus, myometrium pathologies or other factors.

A pseudo-omphalocele is visible on the monitor screen - an erroneous visualization of the exit of the abdominal organs beyond the abdominal wall. Sometimes ultrasound does not "see" significant defects. So, a hernia in shape and echo structure resembles intestinal loops, in this regard, Doppler imaging is of great help, allowing you to see the blood flow.

Our clinic has an excellent 4D apparatus, equipped with all modern capabilities that exclude diagnostic errors.

Stomach

At 16-20 weeks, the fetal stomach is visualized as an anechoic formation of a round or oval shape in the upper abdominal cavity. If the stomach is not filled with amniotic fluid, then we can talk about esophageal atresia (complete absence of lumen).

With a diaphragmatic hernia, the stomach is displaced and also cannot be detected by ultrasound. Also, amniotic fluid is absent with damage to the central nervous system in the fetus.

If the fetus swallows blood with fluid, hyperechoic inclusions are visualized in the stomach. They are also seen in tumors of the stomach, but they are usually accompanied by other malformations. The size of the organ increases with intestinal obstruction, polyhydramnios, thickening of the walls, and the absence of small curvature.

A decrease in the size of the stomach is typical for microgastria, which occurs against the background of an absence of a bladder or an abnormal position of the liver. In 52% of cases, the fetus dies before the 24th week of pregnancy, the child is born unviable.

A slit stomach is characteristic of underdevelopment in the early stages of pregnancy. This pathology is corrected after the birth of the baby: the child is constructed a stomach from a part of the small intestine. The operation is extremely difficult, but the anomaly is not an indication for an abortion.

Gastric atresia is characterized by the absence of echogenicity and involves the formation of a film with or without a hole, located across the walls of the stomach. If this is an isolated pathology, then in 90% of cases it is eliminated surgically. But usually gastric atresia is combined with fusion of the esophagus, ascites (excessive accumulation of fluid), and underdevelopment of the lungs.

Agenesis of the stomach assumes the complete absence of an organ. This is typical of severe chromosomal abnormalities from which the fetus dies during the prenatal period. Ultrasound at 22 weeks is of great importance in diagnosis. some deviations disappear by themselves, and some require immediate intervention.