Variants and abnormalities of digestive system

Lips. A complete or partial cleavage of the upper lip is possible, more often lateral to its median furrow ("hare lip"). Sometimes a crack from the upper lip goes to the wing of the nose. Rarely the cleft of the upper lip reaches the olfactory area of the nose or, bypassing the wing of the nose laterally, reaches the orbit and divides the lower eyelid. Split the lower lip. The absence of one or both lips is extremely rare. Perhaps the asymmetric widening of the mouth slit in one or both sides (macrostom). There is a decrease in the mouth slit (microstoma).

Sky. There is a cleft of the hard palate - non-retina of the palatine processes of the maxillary bones ("wolf mouth"). This anomaly can be combined with the cleavage of the soft palate. There are different combinations of "wolf mouth" and "hare lip". Sometimes the alveolar process of the upper jaw is separated from the remaining parts of the maxillary bone by a deep slit from one or both sides. Perhaps the bifurcation of the soft palate. The tongue is sometimes displaced and reinforced with a base at the back edge of the opener. The size and shape of the tongue also varies. The muscles of the soft palate vary in connection with the varying degrees of possible non-affinity of both halves of the sky. Sometimes there is a wing - a tubular muscle, starting on the medial pterygoid muscle. The wing of the tube muscle is intertwined in the thickness of the mucosa of the auditory tube. Often in the thickness of the palatine aponeurosis is a small muscle that lifts the soft palate, starting on the hook of the pterygoid process.

Teeth. The number of teeth and their interposition are subject to considerable fluctuations. Between the crown and the root of the medial incisors there is an annular or convex thickening of the enamel, resulting from the pressure of the antagonist tooth. On the inner surface of the upper lateral incisors, near the back part of their root, there is sometimes a tubercle. Fangs (especially the lower ones) are often turned on their axis and bent outwards. In rare cases, the fangs do not erupt. Sometimes fangs develop later than adjacent teeth, so because of the lack of space in the dentition, they grow to the side. Premolars can be absent in whole or in part. The number of molar roots can vary. Often the roots converge or diverge in different directions. The roots of adjacent molars sometimes overlap. Often the upper molars (especially the second) have additional chewing tubercles. The third molar (wisdom tooth) may not erupt or appear after 30 years. Often there are additional teeth located on the side of the gum. There are different options for bite.

Language. Rarely absent (agglossia). Blind hole is absent in 7% of cases. Possible splitting of the tongue at the end with the formation of two or three blades. There may be additional muscles, among them a grain-lingual muscle that moves into the thickness of the tongue from the wheat cartilage of the larynx. It is possible the presence of muscle beams in the form of the median longitudinal muscle of the tongue, an additional roto-lingual muscle, an ear-lingual muscle.

Cheeks. The severity of the fatty body of the cheek varies sharply. The configuration of the cheek, the thickness of the buccal muscle, the area of its origin are variable.

Large salivary glands. At the anterior edge of the masticatory muscle there is an additional parotid salivary gland of various sizes and forms. Its outlet duct can be opened independently. Most often it is connected to the excretory duct of the parotid salivary gland. Near the submandibular gland, additional glandular lobules meet at the lateral margin of the chin-hyoid muscle. Additional sublingual glands are possible. The number of small sublingual ducts varies from 18 to 30.

Pharynx. Very rarely there is an absence of pharynx, constriction in one or another part of it. There may be reports of pharynx with skin (branhyogenic fistula), corresponding to uninfected gill slits. Fistulas open at the posterior margin of the sternocleidomastoid muscle, above the sternoclavicular joint, near the mastoid process of the temporal bone. Muscles of pharynx are variable.

The lower constrictor of the pharynx may have additional bundles coming from the trachea. In 4% of cases, the ligamentous-pharyngeal muscle is found. It begins on the surface of the lateral lining of the lower lining and interlaces in the middle or lower constrictors of the pharynx. In 60% of cases there is a perforatrial muscle. Sometimes from it to the right or left parts of the thyroid gland go muscle beams (a muscle that lifts the thyroid gland). From the middle constrictor of the pharynx to the intermediate tendon of the digastric muscle, muscle bundles often leave.

The pharyngeal fascia is sometimes replaced by a partially or completely unpaired throat muscle that connects the pharynx to the skull. Shilohlotochnaya muscle is sometimes doubled in different lengths. It is often intertwined with additional bundles, originating on the mastoid process of the temporal bone (mastoid-pharyngeal muscle) or on the surface of the occipital bone (occipital-pharyngeal muscle). In the area of the pharyngeal arch, one or more pockets (cavities) in the mucosa with dimensions from 1.5 cm in length and 0.5 cm in width (pharyngeal sac) are possible. The pharyngeal bag can be connected to the pharynx-cranial canal.

Esophagus. Possible (rare) lack of esophagus, its infection at different lengths (atresia), the presence of congenital diverticula. Extremely doubling the esophagus, the presence of fistula - connections with the trachea. Sometimes there are fistulas that communicate the esophagus with the skin of the lower part of the neck, at the anterior edge of the sternocleidomastoid muscle. Varies the expression of the muscular membrane of the esophagus. The striated musculature of the muscular membrane is replaced by a smooth one in different parts of the esophagus. The expression of the bronchi-esophageal and pleuropephilic muscles varies, they are absent from the bowl. In 30% of cases in the lower part of the posterior mediastinum, behind and to the right of the esophagus there is a blindly closed serous cavernous esophagus sac 1.5-4 cm long (Saks bag). In 10% of cases, the aorta and esophagus pass through the diaphragm through one aortic aperture. The direction and bends of the esophagus, the number, extent and size of its narrowing significantly vary.

Stomach. Very rarely absent or doubles. Full or partial transverse constrictions of the lumen of the stomach of different shapes and different sizes are possible. They are more often located near the gatekeeper. Varies the thickness of the muscular membrane of the stomach, the number and especially the area of location (extent) of the gastric glands.

Small intestine. Variable shape and relationship with the neighboring organs of the duodenum. In addition to the typical horseshoe shape, an incomplete or full ring-shaped duodenum is often observed. Sometimes the horizontal part of the intestine is absent and the descending part directly passes into the upper part. There may be no descending part of the duodenum. Then the upper part of the duodenum goes directly to the horizontal part.

Rarely there is absence of small intestine, more often - one of its departments - duodenum, jejunum or ileum. The diameter and length of the small intestine often vary. Perhaps lengthening (dolichoholia) or shortening (brachycholia) of the gut. Sometimes there are cases of atresia of different parts of the intestine, the presence of transverse constrictions, diverticula. Perhaps the appearance of Meckelian diverticulum (2 % of cases), which is the remainder of the yolk-intestinal duct of the fetus. Distinguish free, open and closed forms of Meckelian diverticula. With the most frequent free form, the ileal prominence is determined on the side opposite the mesenterial margin. The diverticulum is located at a distance of 60-70 cm (rarely further) from the level of the ilio-cecal transition. The length of the diverticulum varies from a few millimeters to 5-8 cm. A diverticulum of 26 cm in length is described. When the form of the Meckelian diverticulum is open, it is a tube connecting the navel with the bowel with a hole in the navel and in the bowel (congenital intestinal fistula). In some cases, the Meckelian diverticulum is a canal closed at the ends, connected on one side with the navel, on the other - with the bowel (incomplete infection of the vitelline duct). We describe rare cases of the arrangement of the saccular residue of the yolk-intestinal duct, which is not directly related to the intestine in the navel or near it. Sometimes there is a congenital umbilical hernia that appears as a result of non-return to the abdominal cavity of the physiological bulging out of the embryonic gut outward through the umbilical ring.

Sometimes in the mesentery of the small intestine there are muscle beams coming from the front surface of the spine. Occasionally there is a common mesentery of the iliac and cecum.

Colon. Very rarely the intestine is absent or partially doubled. Often there are narrowing of the lumen of the colon (in different parts of it, at different lengths). Often there are various anomalies of the turn of the gut as it develops. Quite often cases of rectal atresia (absence of anal anus), combined with fistula in adjacent organs (or without fistula). There are variants of congenital enlargement and doubling of part or all of the colon, below which there is a narrowing zone (aganglionic megacolon, or Hirschsprung's disease). Frequent variants of the various interrelations between the departments of the colon and the peritoneum are common. In cases of total dolichomegalon (11%), the entire large intestine has a mesentery and an intraperitoneal position. The gut increases in length and width. In 2.25% of cases, a common ptosis (colonization) of the large intestine (colonoptosis) is observed, in which the intestine, having an entire mesentery, descends almost to the level of the small pelvis. Partial elongation and / or ptosis of different parts of the colon is possible.

For the rectum, the presence of a third (upper) sphincter, located at the level of the transverse fold of the rectum, is described. If there is a break in the breakthrough of the anterior membrane, it is possible to close (atresia) the anal opening, which manifests itself in different degrees.

Liver. Vary the size and shape of the right and left lobes (especially the left). Often sections of liver tissue in the form of a bridge are thrown through the lower hollow vein or round ligament of the liver. Sometimes there are additional lobes of the liver (up to 5-6). Near the visceral surface of the liver, at its posterior or anterior margin, it is possible to have an independent additional liver of small dimensions. In the ligament of the inferior vena cava, blindly terminating bile ducts are not uncommon.

The gall bladder. Sometimes the bladder is completely covered with a peritoneum, has a short mesentery. Very rarely the gallbladder is absent or can be doubled. The bladder duct sometimes flows into the right or left hepatic duct. The relationship between the common bile duct and the duct of the pancreas, especially the distal parts thereof, is extremely variable-before entering the duodenum (more than 15 different variants).

Pancreas. The lower part of the head of the pancreas is occasionally elongated and annularly covers the superior mesenteric vein. Very rarely there is an additional pancreas (about 3 cm in diameter) located in the wall of the stomach, sometimes in the wall of the duodenum or in the wall of the jejunum, in the mesentery of the small intestine. Sometimes there are several additional pancreas. Their length reaches several centimeters. The position of the main duct of the pancreas is extremely variable. An additional pancreatic duct can anastomose with the main duct, may be absent or be infected before its confluence on the small papilla of the duodenum. Rarely there is an annular pancreas encompassing the duodenum as a ring. Cases of shortening and bifurcation of the tail of the pancreas are described.

Rarely there is a complete or partial inverse of the normal internal arrangement of the internal organs (situs viscerus inversus). The liver is at the left, the heart is more to the right, the spleen is on the right, etc. The complete reverse arrangement of the intestines occurs in 1 case for 10 million births.