From Big Medical Encyclopedia

PERIDUODENITIS (periduodenitis; grech, peri around, about + armor. duodenum a duodenum + - itis) — inflammatory process of a serous cover of a duodenum.

Distinguish the inborn P. connected with abnormal development of a periduodenalny leaf of a peritoneum, and acquired (secondary), arising owing to the inflammatory changes passing to a serous cover from mucous or muscular covers of a duodenum or the bodies, next to it. Inborn P. meets seldom and has no great practical value. The acquired P., according to some researchers, everything hron accompanies, cankers of a duodenum. By data A. V. Efremova and K. D. Eristavi (1969), P.'s signs come to light at a peptic ulcer in 43,7%, cholecystitis — 22,7%, appendicitis — 18,9%, hron, an adnexitis — 21,9%, a duodenitis — 11,3% of cases. From patol. the processes localized in a duodenum, most often P. develops at a peptic ulcer, is more rare at a duodenitis and a diverticulitis. The item can develop also at diseases of a gall bladder (especially calculous cholecystitis), hron, pancreatitis, hepatitis, appendicitis (especially at a misplaced of a worm-shaped shoot), prick, owing to the closed injury, and also the getting wounds and operative measures on abdominal organs.

In the beginning process has character of an acute inflammation of a serous cover of a duodenum with exudation of the liquid rich with protein and fibrin. On a surface of a serous cover fibrinous exudate which soon is exposed to the organization drops out. The nature of periduodenalny commissural educations can be various — from the gentle arachnoid and filmy imposings located in various sites of a serous cover of a duodenum to rough fibrous tyazhy and plane unions. At inborn P. commissural formations of a serous cover of a duodenum usually thin, tyazhisty with a nacreous shade without signs of an inflammation.

The item of an ulcer etiology is quite often combined with deformation of a bulb duodenum (see). At the same time especially extensive inflammatory and commissural changes arise in case of a penetration of an ulcer. The item developing because of cholecystitis, especially calculous is characterized by formation of unions of a gall bladder with a duodenum.

In certain cases extensive commissural growths at P. can occupy the next bodies, napr, a gall bladder, bilious channels, a stomach, etc. Fibrous and inflammatory changes of a serous cover of a duodenum, its commissure with the next bodies, hems, crossing points and banners can cause deformation of a gut to some narrowing of its gleam.

Clinically It is difficult for item to distinguish from a basic disease or from involvement in patol, process of the next bodies. By data A. V. Efremova and K. D. Eristavi (1969), P. in 41,5% of cases proceeds asymptomatically. In other cases it is followed by a pain syndrome of various degree: constant or periodic pains, as a rule, amplifying after food disturb. They are usually localized in an anticardium or in right hypochondrium, are followed by feeling of weight and a raspiraniye in an upper half of a stomach; irradiation of pains in a back can be noted. Pain amplifies at a bystry postural change of a body, in a prone position on the left side, a deep breath, an exercise stress, concussions of a body. At P.'s combination with pericholecystitis (see) pains have the pristupoobrazny character inherent to diseases of a gall bladder with irradiation, typical for them. Similar attacks come to the end with feeling of dull aches in right hypochondrium, amplifying after food. At P.'s combination to a pericholecystitis of pain can irradiate to the area of heart. Also dispeptic phenomena are observed, often arises eructation (see).

Klien, a picture P., developing owing to a peptic ulcer, can remind symptomatology of aggravations peptic ulcer (see) even after healing of an ulcer.

P.'s current usually wavy, is frequent with a seasonal recurrence; the physical and emotional overstrain, disturbance of food, and also an aggravation of a basic disease can provoke them. The general condition of patients usually suffers a little.

At the expressed aggravation of a basic disease and the related P. it is possible to note at percussion of a front abdominal wall strengthening of pains in the field of an epigast-riyaa of the right hypochondrium. At a palpation morbidity in an upper right quadrant of a stomach, especially along an upper half of the right edge of a direct muscle or in right hypochondrium, according to a projection of a gall bladder is defined.

Diagnosis establish on the basis a wedge, data. With the help duodenoskopiya (see) it is possible to reveal deformation and disturbance of mobility of a duodenum, hypostases, a hyperemia of her mucous membrane. A laparoscopy (see. Peritoneoskoliya ) allows to establish the nature of commissural process with the next bodies and fabrics.

At P. to any etiology careful rentgenol, to a research subject a duodenum, bilious ways, antral department of a stomach, a pancreas and the right half of a large intestine. If necessary usual rentgenol, the research of a duodenum is supplemented with a duodenografiya in the conditions of artificial hypotonia (see. Duodenografiya relaxation ), a holetsisto-holangiografiya (see. Holegrafiya ) or irrigoskopiya (see). Changes of a form and position of a duodenum at P. differentiate with the deformations caused by pressure upon a wall of a gut of the increased gall bladder, a head of a pancreas, the liver inflated by gas of a gut, a tumor of an abdominal cavity, etc., and also with different spastic deformations.

Rentgenol, a picture P. depends on the nature of commissural process (limited or widespread), its localizations (nadbryzheech-ny or submesenteric) and degrees of manifestation, and also involvement in process of the next bodies. The main rentgenol, P.'s symptoms are permanent deformation of a duodenum, change of usual provision of its parts, restriction of passive and active mobility in the field of commissures and various degree the narrowing of its gleam which sometimes is followed by suprastenotichesky expansion of a gut. Contours of the narrowed site uneven. The relief of a mucous membrane is broken, convergence of folds to the site of the maximum narrowing is quite often observed.

Fig. 1. The roentgenogram of a pyloric part of a stomach and duodenum in the conditions of a double contrast study at a periduodenitis of an ulcer etiology: the gleam of a duodenum is sharply narrowed, the ampoule (bulb) has it the form of a shamrock; the arrow specified a bottom of the cicatrizing ulcer.
Fig. 2. The roentgenogram of a duodenum in the conditions of artificial hypotonia at the periduodenitis caused by the ulcer located out of an ampoule (bulb) of a duodenum: the gleam of the descending part of a gut is sharply narrowed (1) as a result of cicatricial and commissural process in the field of an ulcer (2).

Changes of the bulb taking the form of a shamrock, a flame of a candle, hourglasses with formation of narrowings and divertikulopodobny protrusions (fig. 1) are characteristic of P. of an ulcer origin. Its contours at the same time uneven, gear, the smeshchayemost is limited. Upon transition of cicatricial and commissural process from a bulb to area of the gatekeeper there are changes of its form: it is bent, shortened and displaced, being located excentricly in relation to a bulb. At the ulcers located out of a bulb the upper bend and an upper half of the descending part of a duodenum is deformed. The narrowings (fig. 2) arising at the same time are asymmetric, and extent them usually does not exceed 1,5 cm. Cicatricial and commissural process can lead to shortening of a duodenum, and also deformation of the bodies, next to it.

Upon transition patol, process on the next bodies rentgenol, the picture P. is supplemented with signs pericholecystitis (see), perigastritis (see), etc.

Treatment preferential conservative. The great value is attached to purpose of the sparing mode, dietary food, antiinflammatory and antispasmodics depending on a phase of a current of a basic disease. Apply thermal procedures (hot-water bottles, applications of paraffin, ozokerite), light massage of a stomach, physiotherapy exercises. The favorable effect is brought by physical therapy (UVCh, mud cure, an electrophoresis from ronidazy, etc.), it is possible to use x l shout a bottom-natriye to the Vyya, radonic and iodine-bromine mineral bathtubs.

At unsuccessful conservative treatment in certain cases of P. caused, e.g., by diseases of a gall bladder or a worm-shaped shoot operational treatment (a cholecystectomia, appendectomy) is recommended. The indication to operational treatment is the resulting G1. partial obstruction of a duodenum. In this case make a partial resection of a stomach with recovery of passability of a duodenum. If the stenozirovaniye of a gut is caused by a separate connective tissue crossing point, then it in some cases manages to be crossed at a laparoscopic research.

Forecast it is connected with a current of a basic disease. Temporary disability most often depends on an aggravation of a basic disease. In some cases P. with disturbance of evakuatorny function of a duodenum is possible permanent disability.

Prevention it is directed to the prevention and treatment of diseases against the background of which development of the Item is possible.

Bibliography: Vasilenko V. of X., Mayorov V. M. and With and l m and M. M N. Extra-bulbous ulcers of a duodenum, M., 1975; Efremov A. V. both Three hundred in and K. D. Diseases of a duodenum, page 111, M., 1969; Mirzayev A. P. Duodenal staz, JI., 1976; Parfyonov A. P. Physical remedies and resort factors, JI., 1968; Rabukhina N. A. and Sal-m and M. M N. Recognition of diseases of a duodenum and the bodies surrounding it by means of a duodenografiya, M., 1966; Speransky A. P. iro-kityansky V. N. Ultrazvuk and his medical use, M., 1970; Fanar-d I am V. A N. Radiodiagnosis of diseases of a digestive tract, t. 2, Yerevan, 19 £4; Alimentary tract roentgenology, ed. by A. R. Margulis a. H. J. Burhen-ne, St Louis, 1973; Gastroenterology, ed. by H. Bockus, v. 2, Philadelphia — L., 1976; Kaufman S. A. a. L e v e n e G. Postbulbar tfuodenal ulcer, Radiology, v. 69, p. 848, 195?; Teschendorf W., Ana-c k e r H. u. T h u r n P. Rontgenologische Differentialdiagnostik, Bd 2, Stuttgart, 1978.

A.S. Belousov, T. L. Kozhevnikova, A. H. Knshkovsky (rents.).