Today, intestinal rupture is quite rare. Such an unpleasant situation can occur for a variety of reasons. The problem is quite serious. If you notice symptoms that are pronounced, you should immediately call an ambulance.
Causes of bowel rupture
Many people are not even aware of the possibility of such a problem. The reasons for its occurrence can be very diverse. Most often, this happens due to a strong and sharp blow to the region of the anterior abdominal wall. Also, a rupture of the intestine can occur due to internal exposure to the walls of gases or a variety of foreign objects.
Exogenous effects as a cause of rupture
When there was a strong and sharp mechanical effect on the anterior abdominal wall of the body, an intestinal rupture occurs. I must say that this situation ends with the death of the victim, if he does not have time to provide professional assistance on time. Most often, bowel rupture occurs in an accident. When the vehicle abruptly stops moving due to a collision with an obstacle, the passenger and driver continue to move forward by inertia. This leads to a strong impact on the steering wheel, own knees or dashboard. In rare cases, there may be an impact on the seat belt, which has been improperly fastened. This is sometimes observed in child seats. If a passenger or driver has not been fastened with a seat belt, then the time of a car accident can throw them through the windshield. This will lead to an even stronger blow.
You can get a similar injury if you are a pedestrian and injured by a car collision.
Regardless of the case, the basis of pathogenesis can be called a sharp blow to the abdomen, which leads to an additional increase in intra-abdominal pressure. A large role is played by the presence of such a factor as the accumulation of gases in the large intestine. If the lumen narrows sharply, the gas pressure will increase, which greatly increases the risk of bowel rupture.
Since the large intestine is constantly in some movement, its defeat is very rare. More often, you may encounter a rupture of other internal organs located in the abdominal cavity. In most cases, there is a rupture of the spleen or liver. Organs located in the pelvis and retroperitoneal space - kidneys, bladder, can also suffer.
Adhesions in the abdominal cavity
The greatest risk is a rupture of the intestines (thick and / or thin) in the presence of adhesions in the abdominal cavity. Since adhesions are incredibly firmly able to fix the walls of the intestine, its mobility decreases several times. Sometimes you may encounter situations where the adhesion is too tightly attached directly to the wall of the intestine. When it begins to separate, it can tear not only the intestine, but also the area that is nearby.
Adhesions in the abdominal cavity may appear due to an inflammatory process or as a result of surgical intervention. A process such as the appearance of adhesions is considered to some extent a protective reaction of the body, which allows you to set boundaries for the inflammatory process and prevent it from spreading further. When the inflammation has a neglected form, an effusion begins to appear. It contains a huge amount of fibrin and other various substances. Fibrin begins to glue together the walls of the intestine and does not allow the inflammatory process to spread to other parts of the small or large intestine. Adhesions are an irreversible process, therefore, these formations will remain with the person for life. The presence of tumors increases by several times the risk of bowel rupture, compression by a hernial sac, overfilling with a large amount of feces or gases.
Intestinal obstruction as a cause of bowel rupture
If a person suffers from intestinal obstruction, then due to a strong obstruction of the lumen of the directly distal sections, there is an expansion due to the accumulation of feces, gases, and fluid. A similar situation can occur due to inversion of the intestine, prolonged delay in stool. The large intestine swells to such a size that even a minor mechanical effect can provoke a rupture.
The risk of rupture increases if a person suffers from Crohn's disease, colitis or ulcerative colitis of a non-specific type. The intestinal wall becomes weaker, which makes it very vulnerable.
Iatrogenic
Ruptures can occur due to intraluminal endoscopic intervention in the large intestine. The complication most often occurs due to the incorrect and abrupt introduction of the colonoscope. The risk is increased if the patient suffers from serious bowel disease. If all safety rules are followed during an endoscopic examination, the risk of injury is minimal.
Sexual perversions
If a voluntary or forced introduction of a foreign object into the anus has occurred, then this can cause a rupture of the sigmoid colon. In recent years, the problem has become more common. In the hospital, no one is already surprised if people with a foreign object in the anus seek help.
If after non-standard sexual entertainments in the rectum small foreign bodies remain, this can cause the development of a pressure sore wall, and then perforation.
Other reasons
Also, rupture of the intestines and other organs of the abdominal cavity can occur in the following situations:
- Falling from a great height due to negligence or attempted suicide.
- Defeat a person by a blast wave.
- Due to the jump into the water from the big water.
- A bowel rupture may be associated with sports injury.
- A gunshot or stab wound.
Signs of injury
All the symptoms that arise as a result of a rupture of the small or large intestine have one common name - an acute abdomen. Symptoms of a bowel rupture are as follows:
- Strong sharp pains appear in the lower abdomen. The painful sensations are stable and are not eliminated by painkillers.
- The abdominal muscles are in constant tension. During palpation, painful cramps can be felt.
- If there was a rupture of the upper intestine, then vomiting of feces and blood in the feces are observed.
- Bitterness is felt in the mouth.
- Frequent urge to defecate is false.
- A strong ripple is felt at the gap.
In the event of the appearance of these symptoms, it is necessary to urgently consult a doctor, since the consequences of a bowel rupture can be very deplorable.
Diagnosis of the disease
Sigmoidoscopy and colonoscopy cannot be used to diagnose intestinal rupture. In this situation, the only acceptable examination method is fluoroscopy. To make a diagnosis, you can additionally do an ultrasound of the abdominal cavity. The formation of too many gases will also indicate serious damage to the intestines. Violations can be varied - rupture of the mesentery of the intestine, disorders of the small and large intestines, etc.
During the examination, you need to pass a general blood test. In the case of an increased number of sticks (the normal indicator is 2, and the acceptable indicator is 45), if the leukocytes are significantly reduced, then it is worth immediately proceeding to the examination of the intestinal section of the patient. If the analysis showed that there are more than 20 nuclear rods in the blood, then we can say with confidence in 90% about the presence of intestinal perforation. In the same case, blood in the stool is often observed.
Treatment
Surgery is considered the main step in the treatment of rupture of the small or large intestine, other injuries of a through nature. For surgery, general anesthesia is used. If the patient has any contraindications, then spinal anesthesia is used.
If the rupture did not occur in the abdominal cavity, then only dissection will be sufficient. Doctors will clean the fistulous canal and disinfect it. Then you need to thoroughly rinse the cavities located near the intestines: the bladder, vagina in women. After such manipulations, the incision must be sutured. Such operations are considered the simplest and do not take much time. If after surgery the patient did not have any complications, then the next day he will be discharged from the hospital.
If an intestinal rupture has occurred in the abdominal cavity, an abscess (peritonitis) may occur. In this case, it is necessary to rinse the entire contents of the intestine, as well as the abdominal cavity. It is important to disinfect the blood and fill it with electrolyte solutions. If the patient has lost a lot of blood, then transfusion is indispensable.
If more than 30% of the intestine has been damaged, then bowel resection is performed . As a result, the length of the affected section decreases. After resection, the digestibility of food decreases several times. Some patients already within half an hour after they eat, have the urge to defecate.
In the event of complications due to rupture of the intestines (inflammation of the pancreas, liver), a person should permanently exclude fatty, fried and spicy dishes from his diet. If the pancreas has been disrupted, then it is necessary to artificially regulate the level of sugar in the blood.