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 intestinal 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 anterior abdominal wall. Also, intestinal rupture can occur due to internal effects on the walls of gases or various foreign objects.
Exogenous influence as the cause of the gap
When there was a strong and sharp mechanical impact on the anterior abdominal wall of the body, then there is a rupture of the intestine. It must be said that such a situation ends with the death of the victim, if he does not have time to provide professional assistance in time. Most often there is a rupture of the intestine during an accident. When a vehicle stops moving abruptly due to a collision withobstacle, the passenger and the driver continue to move forward by inertia. This results in a strong impact on the steering wheel, your own knees or the dashboard. In isolated cases, the impact of a seat belt that was not properly fastened may occur. This is sometimes seen in child seats. If the passenger or driver was not wearing a seat belt, then during a car accident they could be thrown out through the windshield. This will result in an even stronger hit.
You can get a similar injury as a pedestrian and get hit by a car.
Regardless of the case, the basis of pathogenesis can be called a sharp type of blow to the abdomen, which leads to an additional increase in intra-abdominal pressure. An important role is played by the presence of such a factor as the accumulation of gases in the large intestine. If the lumen narrows abruptly, the gas pressure will increase, greatly increasing the risk of intestinal rupture.
Since the large intestine is constantly in some movement, its defeat is very rare. More often you can 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 small pelvis and retroperitoneal space - kidneys, bladder can also be affected.
Adhesions in the abdomen
The greatest risk of rupture of the intestine (large and / or small) in the presence of adhesions in the abdominal cavity. Since adhesions can incredibly firmly fix the walls of the intestine, itmobility decreases several times. Sometimes you may encounter situations where the adhesion is too firmly attached directly to the intestinal wall. When it begins to separate, it can tear not only the intestine, but also the area that is located nearby.
Adhesions in the abdominal cavity may appear due to inflammation or as a result of surgery. A process such as the appearance of adhesions is to some extent considered 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 the walls of the intestine together and prevents the inflammatory process from spreading to other parts of the small or large intestine. Spikes are an irreversible process, therefore, these formations will remain with a person for life. The presence of tumors, compression of the hernial sac, overflow with a large amount of feces or gases increases several times the risk of intestinal rupture.
Intestinal obstruction as a cause of intestinal rupture
If a person suffers from intestinal obstruction, then due to strong obstruction of the lumen of the immediately distal areas, expansion occurs due to the accumulation of feces, gases, liquids. A similar situation may arise due to intestinal volvulus, prolonged stool retention. The large intestine swells to such a size that even a slightmechanical impact can cause a rupture.
The risk of rupture is increased if a person has Crohn's disease, colitis, or non-specific ulcerative colitis. The intestinal wall becomes weaker, making it very vulnerable.
Iatrogeny
Ruptures may occur due to intraluminal endoscopic intervention in the large intestine. The complication most often occurs due to incorrect and abrupt insertion of the colonoscope. The risk is increased if the patient suffers from severe bowel disease. If all safety rules are followed during an endoscopic examination, then the risk of injury is minimal.
Sexual perversions
If there was a voluntary or forcible introduction of a foreign object into the anus, this can cause a rupture of the sigmoid colon. In recent years, the problem has become more and more common. In the hospital, no one is surprised anymore if people with a foreign object in the anus seek help.
If, after non-standard sexual entertainment, small foreign bodies remain in the rectum, this can cause the development of a decubitus wall, and then perforation.
Other reasons
Also, rupture of the intestines and other abdominal organs can occur in the following situations:
- Falling from great heights due to negligence or attempted suicide.
- The defeat of a person by an explosive wave.
- Due to jumping into the water from big water.
- Intestinal rupture may be related to sports injury.
- Gunshot or knife wound.
Signs of injury
All the symptoms that occur as a result of rupture of the small or large intestine have one common name - an acute abdomen. Symptoms of intestinal rupture are as follows:
- Severe sharp pains appear in the lower part of the abdomen. Pain is stable and cannot be relieved by painkillers.
- The abdominal muscles are in constant tension. During palpation, painful spasms can be felt.
- If there is a rupture of the upper part of the intestine, then there is vomiting of feces and blood in the stool.
- Mouth feels bitter.
- There are frequent false urges to defecate.
- There is a strong pulsation at the rupture.
If these symptoms appear, you should immediately consult a doctor, as the consequences of intestinal rupture can be very deplorable.
Diagnosis of disease
Sigmoidoscopy and colonoscopy cannot be used to diagnose intestinal rupture. In this situation, the only acceptable method of examination is fluoroscopy. To make a diagnosis, you can additionally do an ultrasound of the abdominal cavity. Also, the formation of too much gas will indicate serious damage to the intestines. Violations can be varied - gapintestinal mesentery, disorders of the small and large intestine, etc.
During the examination, you need to take a general blood test. In the case of an increased number of sticks (the normal figure is 2, and the permissible figure is 45), if the leukocytes are significantly reduced, then it is worth immediately starting to examine the patient's intestinal section. If the analysis showed that there are more than 20 nuclear rods in the blood, then we can talk with 90% confidence about the presence of intestinal perforation. In the same case, blood in the stool is often observed.
Treatment
Surgical intervention is considered the main stage in the treatment of rupture of the small or large intestine, other injuries of a penetrating nature. General anesthesia is used for the operation. 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 do a thorough washing of the cavities located next to the intestines: the bladder, the vagina in women. After such manipulations, the incision must be sutured. Such operations are considered the simplest and do not take much time. If the patient does not experience any complications after the surgery, the patient is discharged from the hospital the very next day.
If an intestinal rupture occurs in the abdominal cavity, an abscess (peritonitis) may occur. In this case, it is necessarywash the entire contents of the intestines, 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 a transfusion is indispensable.
If more than 30% of the intestine was damaged, then the intestines are resected. As a result, the length of the affected section decreases. After resection, the digestibility of food decreases several times. Some patients have an urge to defecate within half an hour after they eat.
In case of complications due to intestinal rupture (inflammation of the pancreas, liver), a person should permanently exclude fatty, fried and spicy foods from his diet. If the work of the pancreas has been disrupted, then it is necessary to artificially regulate the level of sugar in the blood.
