Rupture of various parts of the colon in peacetime is quite rare and can occur for various reasons. Rupture and other traumatic injuries of the colon can occur due to a sharp blow to the anterior abdominal wall, and exposure of the colon from the inside to gases or foreign objects. The large intestine begins in the right ileal region and connects end to side with the small intestine in the area of the cecum (see photo). Next, the cecum passes into the colon, consisting of an outgoing, transverse, and descending part. The descending part of the colon passes into the sigmoid colon, which is the final part of the large intestine. The sigmoid colon, in turn, passes into the rectum.
Rupture of any part of the colon leads, first of all, to such a serious complication as fecal peritonitis. Fecal peritonitis is a severe form of inflammation of the peritoneum, which develops as a result of feces containing a large number of microorganisms entering the sterile abdominal cavity. This condition is subject to emergency surgical intervention, total laparotomy, rinsing the entire abdominal cavity with an antiseptic solution, suturing the rupture or resection of the intestine, depending on the nature of the damage. But, even despite emergency surgery, the mortality rate from this form of peritonitis still remains high.
What is a gap and the main reasons
Pathology associated with rupture of the intestinal walls is a dangerous condition that requires immediate medical attention. A similar phenomenon can occur in both the large and small intestines. In ICD 10, this pathology is assigned code S 36 - abdominal injuries.
In medical practice, rectal rupture is often encountered, that is, damage localized in the final section of the large intestine is a dangerous lesion of the wall, which often ends in death.
Ruptures of the small intestine are also a common form of pathology. This is due to the fact that the small intestine is long and relatively unprotected. In addition, the intestine can rupture in the sigmoid, duodenum and other sections.
Intestinal damage has been identified as a cause.
- Accumulation of fecal stones in the gastrointestinal tract. This factor is characteristic of the rectum.
- The sudden development of pathology under the influence of excessive stress on the walls - labor, heavy lifting, difficult bowel movements requiring intense pushing, weightlifting.
- The presence in the abdominal region of various foreign bodies that have an endogenous mechanical effect on the walls. More often, this situation occurs in childhood and adolescence.
- Oblique blows to the abdominal area. In such a situation, the mesentery is injured, as a result of which the intestines are torn off.
- Carrying out a dangerous surgical intervention or unqualified medical actions. In this situation, the rupture is a complication of exogenous mechanical impact.
- Severe intestinal obstruction. This pathology causes many complications and requires qualified treatment.
- Closed intense injury to the stomach, abdomen, caused by a fall, blow, or accident. Depending on the degree of emergency, associated injuries may vary in nature and severity.
- The rectum is injured during unconventional sexual intercourse or improper administration of a cleansing enema.
- Development of benign and malignant neoplasms in the organs of the digestive system.
Intestines
Important! It is impossible to independently determine the causes of the rupture; such an injury requires emergency qualified assistance.
Disease prevention
No one is immune from injuries and unforeseen situations in life. But at the same time, you can protect yourself by eliminating at least some provoking factors, which mostly depend on the person:
- watch your diet. Avoid foods that are heavy on the stomach, which can cause constipation, which then causes stretching of the intestinal walls and their thinning;
- lead an active lifestyle - moderate physical activity improves digestion and peristalsis;
- If you experience any alarming symptoms that may indicate gastrointestinal diseases, you should immediately consult a doctor.
The mechanism of closed injuries of the small intestine is different. More often it is a direct blow to the stomach, compression between two planes. The pathogenesis of various types of morphological changes is associated with the action of a traumatic factor, primarily with the force of the blow. With a direct blow to the stomach, a loop of the small intestine is pressed against the spine or pelvic bones, the intestinal wall is ruptured, sometimes crushed, the intestine is torn off from the mesentery, or only the mesentery is ruptured. The mesentery of the small intestine is damaged in approximately 70% of cases.
Hematomas of the intestinal wall deserve special attention. Hematomas visible through the serous membrane are the result of damage to the mucous and muscular membranes. Extensive hemorrhages into the intestinal wall lead to the formation of secondary necrosis followed by perforation.
Shock with isolated injuries of the small intestine is observed in 30%, with polytrauma – in 80% of victims. With intra-abdominal hemorrhage, the blood does not clot and mixes with the intestinal contents. Significant hemorrhage into the free abdominal cavity occurs when the small intestine is damaged and is separated from the mesentery over a large area, while large mesenteric hematomas can spread into the retroperitoneal space. The separation of a loop of the small intestine from the mesentery over a long distance not only jeopardizes the viability of the intestinal wall, but also often leads to significant bleeding into the free abdominal cavity.
Somewhat later, 6-12 days after injury and surgery, secondary necrosis of the wall of the small intestine may unexpectedly appear, while the clinical manifestations of the injury first subside, and then “unexpectedly” peritoneal syndrome increases.
Symptoms of intestinal rupture
The main and main symptom of intestinal rupture is acute, pronounced, sudden pain. From pain, a person can lose consciousness and go into a state of shock. The symptoms of this pathology are sudden and intense.
A person’s condition is deteriorating at an incredible rate, so it is extremely important to seek medical help in a timely manner. The main signs of pathology include:
- intense vomiting, nausea, most often, the vomit contains streaks of blood, bile,
- symptoms of internal hemorrhage, that is, a sharp decrease in blood pressure, tremors of the limbs, cold sweat,
- the main symptom is a sharp, extremely severe pain of a paroxysmal and cramping nature, while it is impossible to trace the general localization,
- increased body temperature, symptoms of fever are the most recent clinical picture indicating the development of peritonitis.
Sharp pain
The manifestation of such symptoms is a good reason to consult a doctor. Even if there is no intestinal rupture in the body, such signs are evidence of dangerous diseases.
Please note that immediate treatment for intestinal rupture significantly reduces the risk of death.
General symptoms of the disease
Constipation, diarrhea
If a person has stool (defecation) once a day, there is no reason to worry. If this happens once every 3 days or more, or vice versa 2-3 times a day, we can talk about a violation of the intestinal evacuation ability, possibly the development of hypomotor dyskinesia. In this case, the processes of absorption of nutrients and digestion do not work 100%. An additional reason may be diseases of other digestive organs, whose work must be performed by the large intestine.
Pain, bleeding during bowel movements
The presence of constant pain indicates the development of inflammation. Ignoring this signal and lack of treatment leads to colon cancer. If you eat low-quality food, food is quickly eliminated without digestion. You should also be alarmed by a constant feeling of expansion in the abdomen, increased gas production, and rumbling.
The appearance of blood discharge during bowel movements indicates internal bleeding, possibly due to a rupture of the colon, and their color indicates an arterial or venous origin.
This is a serious reason for an endoscopic examination of the digestive system.
Anemia
Anemia occurs in the case of constant or acute bleeding from internal organs. With intestinal cancer, anemia occurs due to chronic blood loss and disruption of the formation of blood cells - platelets, leukocytes, erythrocytes.
Necessary diagnostic tests
Diagnostic measures are of great importance before prescribing treatment or performing an operation. This is the only way a doctor can verify the correctness of the diagnosis and determine the area and degree of the disorder.
The first thing to do in case of a rupture is to collect anamnesis and determine what type of injury was received. The initial collection of information helps to avoid complications and form a complete clinical picture, based on which a medical specialist can prescribe further procedures.
- Palpation of the intestinal condition allows you to determine the condition and progression of the rupture.
- An X-ray examination is carried out to identify the location of the disorder and the degree of development.
- Ultrasound analysis allows you to assess the condition of other internal organs and detect bleeding.
- Laparoscopy is an effective diagnostic method that involves the use of minimally invasive intervention. In addition, a similar method is used to treat various pathologies.
- Computed tomography or magnetic resonance imaging is an effective, modern diagnosis that allows you to most accurately visualize the state of intestinal damage.
Ultrasound
Diagnostics before surgery is mandatory, since it allows you to collect the necessary information and minimize the risk of developing life-threatening complications for the patient.
Diagnostics
To begin the examination, you first need to talk with the patient and find out what kind of injury was received, what diseases of the gastrointestinal tract are present, or what provoking factors occurred. This is necessary to determine at least approximately what studies need to be carried out and which particular area of the intestine to examine.
Next, the following studies are prescribed:
Closed injuries are more difficult to diagnose than open ones. In addition, if there was no obvious trauma, then the situation is complicated by the fact that the root cause must first be determined.
List of consequences of a breakup
Even a slight distension of the intestine poses a huge health hazard, and when this organ ruptures, extremely complex complications can develop. Intestinal rupture in most cases is accompanied by the development of massive hemorrhage, and therefore there is a huge risk of death.
Violation of the integrity of this hollow organ can lead to the development of the following complications.
Peritonitis
Unskilled care, absence or untimely therapeutic intervention increases the risk of complications and, therefore, worsens the chances of recovery.
Treatment
As previously stated, the main treatment for rectal rupture is surgery. The patient undergoes surgery and rehabilitation therapy simultaneously. A rupture or crack in the intestine is repaired by suturing only after the appearance of puncture or cut wounds, provided there is no suppuration or inflammation.
For intra-abdominal injuries, the surgeon makes an incision in the abdominal wall from the front to view the intestines, liver and stomach. Examination is necessary to diagnose concomitant organ damage.
If the intestine has suffered minor damage, the surgeon will simply suture the damaged area, but if serious damage has occurred, the affected area of the intestine will be removed and then the intestine will be sutured in several layers. The integrity of the rectum can be fully restored after at least 3 months.
Damaged rectum
If a person has damaged the rectum, then it is important for him to know the reasons, and they can be both external and internal, which destroy the integrity of the organ and the body as a whole. Such damage is serious and requires special treatment and care of the injured area.
Advice: if you have injured your rectum, immediately consult a specialist for advice, diagnosis and advice on further treatment.
Pay due attention to intestinal injuries and consult a doctor promptly.
Causes
As mentioned above, wounds directly to the intestine can have external/internal factors. External factors include the following:
- gunshot wounds;
- knife wounds;
- injuries from medical instruments;
- injuries caused by falling on sharp objects;
- rupture of the rectum from the introduction of air.
Internal factors:
- high (exceeding normal) intra-abdominal pressure;
- excessive physical activity;
- complications during childbirth;
- difficulty with bowel movements;
- anatomical features of the body;
- sphincter injuries.
Please note: rectal trauma often affects other organs or bones. For example, if you get into an accident, the pelvic bones may be injured along with damage to the rectum and other internal organs.
Classification
Classification, for these damages there are several types:
- by the mechanism of injury;
- according to the amount of injury received.
In the first case, injuries are divided into the following types:
- received during mechanical actions (for example, surgery);
- falling, receiving mechanical injuries, bruises, wounds;
- during sexual intercourse without the use of special means;
- perineal burn;
- pelvic girdle injury.
Based on the volume of injury, injuries are divided into:
- those located in the abdominal cavity;
- those that are outside the abdominal cavity.
The above defects can be divided into:
- simple;
- complicated by impaired functioning of the sphincter;
- complicated by impaired functioning of other internal organs.
Symptoms
Injuries to the rectum have pronounced symptoms. If the muscle or mucous membrane of an organ is damaged, a person experiences the following symptoms:
- sharp pain in the area of the damaged organ;
- the presence of blood in the excreted stool;
- false urge to defecate;
- involuntary release of gas or feces (due to uneven enlargement of the anus);
- the presence of purulent discharge;
- progress of the inflammatory/infectious process.
Please note: if you notice any of the above symptoms that may develop after injury, contact your healthcare professional immediately.
Ignoring the manifestations of pain and disturbances in the normal functioning of the small intestine can cause death.
Take care of your own health and contact a specialist, thereby increasing your chances of timely and effective treatment.
Diagnostics
After detecting the above symptoms and contacting a doctor, you should conduct an external examination of the perineum and anus to determine damage to the rectum. Rectal injuries can be diagnosed in various ways depending on a number of factors (features of injury, degree, size, pain).
Diagnostics consists of several stages:
- rectal examination (palpation);
- examination using a mirror (special medical rectal mirror);
- anoscopy (examination using a special instrument - anoscope);
- undergoing an ultrasound examination;
- abdominal radiograph;
- use of a catheter for further examination of the body.
The specialist may suggest several other inspection methods. It depends on the individual characteristics of the patient, the nature of the injury, and other things. Be careful when selecting a medical professional. You must completely trust the doctor, feel comfortable during the appointment and be confident in the doctor’s qualifications.
Treatment methods
Injuries to the rectum, depending on the size of the wound, its current condition, size and discomfort it brings to the person, may be subject to different types of medical therapy.
The initial action that is carried out after contacting a medical center is surgical treatment. The damaged intestine is treated, then sutures are applied (this involves inserting a special gauze, which is covered with a medicinal antiseptic ointment, into the small intestine).
In especially severe cases, the damage is tamponed, disinfected, and sutured using a special technique (so as not to disrupt the connection with the intestine).
If the damage to the small intestine is not critical, the patient is offered a form of conservative treatment such as bed rest, which includes:
- constant administration of an enema (several times a day);
- use of antibiotics, anti-inflammatory ointments, and antibacterial agents prescribed by the doctor;
- ingestion of essential oils;
- adherence to a specific diet (depending on the individual characteristics of the body, prepared by a doctor);
- suturing of defective areas of the organ;
- complete sanitation of the abdominal cavity;
- the rectum should not be overloaded (due to diet).
The duration of bed rest associated with rectal damage can vary from 2 months to six months.
Please note: timely contact with a doctor and, accordingly, treatment guarantees a complete recovery in more than 80% of cases. If you ignore the manifestations of the disease and refuse complex therapy, this injury can be fatal. Statistics indicate that the mortality rate for such injuries is 30%.
Source: https://PishcheVarenie.ru/pryamaya-kishka/eshe/povrezhdena-pryamaya-kishka.html
