Minuscauses of the esophagus are not clinically recognized and are found accidentally on the cover of children who died from various causes. It is especially difficult to make such stenoses in young children.
The cause of death of esophageal stenosis is a violation of the vacuolization of the primary intestinal tube, resulting in a thickening of all layers of the esophagus (hypertrophy muscle layer, the appearance of mucous membranes, abnormally developed vessels, etc.).
Morphologically, there are several types of congenital narrowing of the esophagus: circular, hypertrophic, membranous (due to thickening of the atypically located membranous membrane). The circular type arises in connection with the inclusion of a fibrous or cartilaginous ring during embryonic formation, hypertrophic - is formed due to hypertrophy of the muscular layer of a certain part of the esophagus, membranous - due to the formation of mucous membranes, which narrows the lumen of the esophagus. The latter type of gastric membrane, which because of its thickness is protruded into the lumen of the esophagus.
Congenital stenosis of the esophagus is localized more often in the middle or lower part of it, less often occurs in the upper third.
Clinical symptoms
Clinical symptoms are caused by the degree of narrowing of the esophagus, its morphology and the patient's age. Significantly narrowing in young children receiving semi-liquid and liquid food, symptoms are poorly expressed, they are often overlooked. With sharply expressed stenosis, the same phenomena as in esophagus arthritis are observed. With the transfer of the child to a more dense food, the symptoms become more distinct.
Classic symptoms are permanent dysphagia and regurgitation during or immediately aftereffect. In 33% of cases of stenosis of the esophagus in children of the first three months of life, there are respiratory disorders in feeding, vomiting and regurgitation. The child feeding becomes uneasy, throws back his head. In children older than six months, hypersalivation appears at times. Vomit consists of unchanging food, mucus and saliva without the acidic odor of gastric contents. The regurgitation with increasing age becomes more frequent and constant, since the muscle layer strength above the constriction is preserved, and it to some extent compensates the difficulty of food passage through the narrowed part of the esophagus. After a while, muscle strength is depleted, decompensation sets in, which leads to continuous and constant regurgitation. The walls of the esophagus above the stenosis lose their elasticity, they are dilated, forming a sacciform extension. The extended pre-intestinal portion of the esophagus shows a compression effect on the trachea, which leads to dyspnea, stridor, cyanosis, coughing attacks. Stagnating in the pre-stenotic expansion, food can be aspirated and lead to the emergence of aspiration pneumonia. In addition, stagnant food undergoes bacterial decomposition; from the mouth there is an unpleasant, rotten smell.
There may be cases of acute obstruction of the esophagus, which occurs as a result of "punching" a dense piece of food into the stenosed section of the esophagus.
Circular and membrane variants of esophageal stenosis are not accompanied by vomiting. Constrictions localized in the ventral part of the esophagus appear in later periods of development of the child (not earlier than 6 months of age), usually by dysphagia, and then by the other above mentioned symptoms. Of the general symptoms of the described anomaly of development of the esophagus, it should be noted the lag in physical development, hypotrophy, hypokinesia (patients try to move less), anemia.
Clinical diagnosis should be confirmed radiographically to establish the localization of stenosis, the nature of the changes in the mucosa of the esophagus. Before the radiopaque examination, the patient is washed with the esophagus to remove food and mucus residues. It is preferable to perform a radiological examination in the horizontal position of the patient with a tight filling of the esophagus. The study is a long one - until the contrast material enters the stomach and the esophagus is emptied. The x-ray clearly shows the narrowing of the esophagus.
The endoscopy of the esophagus has a decisive diagnostic value. Esophagobibroscopy is carried out by preliminary application of relaxants.
Treatment
Treatment in most cases is prompt. With stenoses of a small degree, the treatment is started with bougie by elastic boules inserted through the mouth. In recent times, special dilators have been used. During treatment, buzhirovaniobolnoy should receive liquid and semi-liquid food. If three courses of treatment were not effective, then surgical intervention is performed.
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