Causes of rupture of the rectum and methods of treatment. Symptoms of intestinal rupture: the main causes, treatment methods Injured intestines

- this is an object that has fallen into the lumen of the intestinal tube, which is not subject to digestion processes. The most common causes are accidental ingestion of small toys, balls, coins by children, patients with mental disabilities; possible intentional ingestion of various objects. Symptoms are different: objects may not cause any complaints, large ones can cause severe pain, intestinal obstruction. Diagnosis is based on radiographic imaging, endoscopic examination. Treatment may include expectant management, endoscopic or surgical removal.

General information

Foreign body of the intestine - an object of organic or inorganic origin, which entered the intestine from the outside or formed in the body ( gallstones, bezoars) and, due to the peculiarities of the composition, cannot be subjected to digestion processes. Foreign objects enter the body accidentally or intentionally, they can be single or multiple.

With untimely diagnosis, an inflammatory process, an infiltrate around a foreign body, its suppuration, migration, and the formation of intestinal obstruction or perforation with peritonitis are possible, which can cause death. In some cases, foreign objects can be evacuated naturally, in others surgical intervention is required.

Causes

Foreign bodies of the intestine can enter the body accidentally; most often, small objects (buttons, coins, small parts of toys, balls, key rings) are swallowed by preschool children. Persons with mental disorders can swallow objects (at the same time, quite large and dangerous objects can enter the gastrointestinal tract: spoons, toothbrushes, blades, and others), drug addicts, magicians.

In adults, it is possible for foreign bodies to enter the gastrointestinal tract during meals (bones, dentures), as well as due to the bad habit of keeping any small parts in the mouth during work - a nail, a pin. In the elderly, ingestion of objects is often associated with impaired chewing, reduced sensitivity of the pharynx. Cases have been recorded when objects were deliberately swallowed by prisoners, drug couriers in order to transport them in the stomach.

Foreign bodies of the intestine can form directly in the body, more often in the stomach, followed by movement along the gastrointestinal tract. Hair balls, or trichobezoars, are formed when hair is swallowed, can reach a significant size, migrate to the intestines. More often, such formations are formed in girls with neurosis phenomena, who have the habit of keeping hair in their mouths. Bezoars can be formed when eating a large amount of foods with coarse fiber (pine nuts, persimmons), with the mineralization of a blood clot in the stomach cavity, from dermoid cysts of the stomach, etc.

Foreign bodies can have a traumatic genesis (splinters, bullets, pieces of wood and other objects that fall during wounds) or be left during surgical interventions (non-absorbable suture material, metal staples and paper clips, less often - lost drainage material). Such objects can cause the development of ulceration, anastomosis. In clinical practice, cases of foreign bodies of the rectum, introduced deliberately or for criminal purposes, are also recorded, sometimes such objects can retrograde migrate into the sigmoid colon.

Symptoms

The clinical picture of an intestinal foreign body does not significantly depend on the type of object. If the object is small and moves freely through the gastrointestinal tract, patients do not complain or feel slight pain in the abdomen. Sometimes the pathology is manifested by an intense pain syndrome with an "acute abdomen" clinic. In some cases, the clinical picture resembles that of an inflammatory process, intestinal obstruction, so imitating the symptoms of another disease that diagnosis becomes extremely difficult.

Patients may be disturbed by severe pain in the abdomen, disorder of the stool or its absence. If a sharp object damages the intestinal mucosa, bleeding symptoms appear (blood in the stool). With intestinal perforation with the development of peritonitis, the pain becomes diffuse, the body temperature rises, the patient's condition becomes severe. In the case of localization of a foreign body in the rectum, the clinic is represented by symptoms of low intestinal obstruction.

Diagnostics

In most cases, the diagnosis of a foreign body in the intestine is not difficult. Important role belongs to the assessment of the patient's complaints and anamnesis. Examination by an abdominal surgeon allows you to pre-evaluate the prognosis and determine the tactics of treatment, to draw up a plan for examining the patient. In laboratory tests, in the absence of complications, there are no changes, leukocytosis is possible. Plain radiography of the abdominal cavity makes it possible to visualize a foreign body, assess its size and location.

For foreign bodies of small size, as well as non-contrasting radiography (for example, wood, aluminum, plastic), fluoroscopy is performed with the introduction of a contrast agent. This method of examination allows not only to detect the object, but also to assess the patency of the intestine. Colonoscopy is used to identify objects in the colon, with localization in the rectum - digital rectal examination, if it is insufficiently informative, suspected damage to the intestine, sigmoidoscopy is performed.

Treatment of foreign bodies of the intestine

Treatment tactics depend on the location, size and shape of the object. If there is a small rounded object in the small or large intestine (for example, a metal ball or a coin, a fruit stone), there is no risk of perforation of the intestinal wall, experts adhere to expectant tactics - in most cases, the body leaves the intestine on its own. The patient is under observation in the department of abdominal surgery. If the subject long time lingers in the ileocecal region or other part of the intestine and does not move further, surgical intervention is necessary.

If a pointed object enters the intestine, which can perforate the intestinal wall, an urgent endoscopic examination is performed and, if possible, removal of the foreign body of the intestine (if it is located in the department accessible to the endoscopic technique). The danger is represented by cases when the object is wedged in the area of ​​gastroduodenoanastomoses or gastroenteroanastomoses with stenosis and causes acute intestinal obstruction. Foreign bodies of the rectum are removed under local or general anesthesia after expansion of the anus with a rectal mirror, sometimes surgery is performed - dissection of the anal ring.

Surgeons adhere to special tactics if the foreign body is a non-absorbable suture material. All metal clips, staples and other types of ligatures that are more than a month after the operation and cut into the intestinal lumen are an indication for endoscopic removal, since there is a high risk of developing ulcers, erosions, narrowings. If the drainage of the bile duct left after the operation does not depart spontaneously, it is removed endoscopically, sometimes a laparotomy is performed.

Forecast and prevention

The prognosis is determined by the characteristics of the subject and the timeliness of medical care. Small rounded objects are usually evacuated spontaneously, with the risk of intestinal obstruction and perforation, the operation prevents the development of severe complications. Prevention consists in preventing swallowing of objects, especially by young children: toys must be age-appropriate and not have small parts, games with coins or small balls without adult control are unacceptable, children's designers with small magnetic elements are of particular danger.

The intestine is a necessary organ in the digestive system, which originates from the stomach and ends at the anus. In the intestines, food is digested from which useful substances are extracted, and the processed product is excreted naturally along with toxins and toxins. Sometimes patients turn to a proctologist with organ problems, one of the serious pathologies is colon rupture.

The characteristic of violation of the integrity of the body is closed and open type with intra-abdominal and extra-abdominal localization. Rupture within the colon is common and involves adjacent organs or the sphincter. The depth of the rupture is noted to the depth of the mucous tissues of the organ, hematomas in the submucosal tissues, rupture of all layers of the intestinal walls.

Anatomy of the large intestine

Injury to the rectal organ can occur due to hard hit into the abdominal cavity. Such phenomena are possible during an accident, explosion, great pressure per person, when falling from a high point.

Injury can be different. Starting from strong squeezing, to the occurrence of ruptures in the organ. If a blow is applied perpendicular to the human peritoneum, then most often this leads to a complete detachment of the rectum. This is a dangerous injury that can have serious consequences.

Such an injury is difficult to diagnose, since many injuries are noted inside. There are gaps from a firearm, as well as after applying a cutting or stabbing object to the stomach. Any injury to the rectal organ is treated only with a surgical technique.

Causes

Damage to the organ of the rectum occurs in a number of ways the following reasons:

• fractures of the pelvic bones;
• disturbed technique during enemas (damage to the sphincter, mucous tissues);
• severe labor activity with ruptures of the perineum and rectum;
• wound (gunshot);
• the presence of a foreign object in the anal area;
• trauma to the rectal organ from a fall with a blow to the perineum;
• unconventional sex;
• closed injury with internal bleeding of the peritoneum during a fall from a high point;
• spontaneous injury with a sharp lifting of the load, provoked by intra-abdominal pressure;
• difficult exit of hard feces;
• accidentally swallowed object.

Among cases of rupture of the large intestine, injury by a foreign body is most often noted, especially in young children. Therefore, you should monitor the baby so that he does not take toys with small details into his mouth.

Symptoms

An existing injury to the rectal organ is recognized by the following symptoms:

• severe pain in the lower peritoneum and anorectal canal - pains are similar to contractions, turning into aching symptoms;
• gag reflex with nausea;
• internal blood loss;
• weakening of the general condition;
• fever with chills;
• bloody traces in the feces (a similar symptom occurs from a fistula);
• painful bowel movements;
• frequent gas discharge;
• there is a discharge of feces from the vagina;

If there is at least one sign indicating damage to the organ of the rectum, medical assistance is needed.

Classification

Trauma of the large rectum is divided into degrees of complexity:

• simple break;
• complicated injury with disruption of the sphincter;
• Complicated injury with impaired functionality of other organs inside the peritoneum.

Complex injuries are recognized by the number of ruptures, classified by location (inside the peritoneal cavity or outside it).

The classification of injuries for the selection of medical care is due to the following stages:

• Light trauma - anal fissures with small ruptures of the mucous tissues of the rectal organ. Therapy is carried out for 3-7 days with the use of local medications.
• Injuries of moderate severity - stratification of the rectum and extra-abdominal cavities, varying degrees of ruptures with impaired integrity of the muscles on the abdomen.
• Severe injuries - impaired integrity of the cavity in the abdomen and other organs with complications and the formation of an infectious process.

Diagnostics

The easiest way to diagnose an injury to the large rectum is by probing the abdomen and rectal finger examination of the organ. During a rectal examination, a gloved proctologist inserts a finger into the anorectal canal and feels the mucous surfaces, detecting any damage. This method is effective for recognizing the size, shape, nature of the injury with their localization.

To obtain a more informative clinical picture, the proctologist prescribes other methods for examining the intestine:

• organ testing using a mirror device;
• anoscopic examination - a diagnostic measure using special device(anoscope), which is inserted into the anus, expands the anorectal zone, which makes it possible to more reliably examine the injuries of the organ;
• ultrasound diagnosis of the peritoneum - the entire cavity is visible on the ultrasound machine, in addition, the doctor can recognize other pathological processes in the digestive tract;
• x-ray - x-ray of the intestine. In the pictures, injuries, localization of damage, possible inflammatory processes are clearly recognized;
• sigmoidoscopy is a hardware procedure using a special device in the form of a tube through which air is supplied to the anus (to expand the intestine), after which the doctor can visualize the condition and degree of pathology of the rectal organ.

The technique of research manipulations is appointed by the proctologist on an individual basis.

Treatment

Injury to the large intestine is treated taking into account the size of the wounds, the condition of the organs, and the discomfort of the patient.

After the patient has applied to a medical institution, the patient is examined by a surgeon and treated. After treatment of the damaged intestine, sutures are applied. The surgeon inserts a special gauze coated with a medicinal antiseptic into the small intestine.

In difficult situations, injuries of the rectum require tamponization, disinfection, suturing without breaking the connection with the intestine. If damage to the small intestine is not critical, doctors prescribe conservative therapy with bed rest, regular enemas. The proctologist prescribes the use of antibiotics, ointments with anti-inflammatory and antibacterial efficacy. Also, from additional funds, an internal intake of esters, a dietary diet are prescribed. Defective areas are sutured, the rectum should not be loaded with heavy food.

Nutrition

After surgery, patients are prescribed a diet, antibiotics, and, if necessary, antipyretics (Ibuprofen). The patient should not eat salty, fried, smoked, fatty, indigestible foods. The menu should include dishes cooked by boiling, stewing, steaming. The diet includes cereals, it is allowed to eat fish, lean meat, dried fruit compotes, vegetable stew.

Folk methods

Proctologists have a positive attitude towards traditional medicine. It is allowed to use herbal infusions especially with a laxative effect. They help the passage of feces without stagnation. For better bowel function, it is recommended to drink chamomile decoction. Also a good remedy are infusions with mint, nettle, rose hips. These medicinal preparations have antibacterial, healing effectiveness. The compositions are taken without added sugar.

Laxatives of traditional medicine include: flax seed, oil (castor). A decoction is prepared from flax seed: 1 tbsp. l. raw materials, 230 ml of boiled water is poured, aged for 8 hours. The composition is required to drink after waking up in the morning.

Castor oil is taken along with honey and chicken yolk. To do this, a spoonful of oil is mixed with the same amount of honey and yolk. You can add some water to get a creamy consistency. The remedy is taken twice a day, one spoonful.

Of the general recommendations, proctologists distinguish daily enemas, 2-3 times a day, taking and using medications prescribed by a doctor, a balanced diet, a control study of abdominal ultrasound, and bed rest for three months after wound suturing.

Any injury to the colon and rectum is dangerous. Therefore, after suffering a blow, a fall, an overstrain of the abdominal muscles, it is required to be examined by a proctologist for injury to the organ.

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 the code S 36 - injuries of the abdominal cavity.

In medical practice, there is often a rupture of the rectum, that is, damage localized in the final section of the large intestine - 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 very long and relatively insecure. In addition, the intestine can rupture in the sigmoid, duodenal and other departments.

As the causes of damage to the intestines are isolated.

• Accumulation of fecal stones in the digestive tract. This factor is characteristic of the rectum.
• The sudden development of pathology under the influence of excessive load on the walls - labor, weight lifting, difficult defecation, requiring intense attempts, weightlifting.
• The presence in the abdominal region of various foreign bodies that have an endogenous mechanical effect on the walls. Most often, this situation occurs in childhood and adolescence.
• Oblique blows in the abdomen. In such a situation, the mesentery is injured, as a result of which the intestine comes off.
• Carrying out a dangerous surgical intervention or unskilled medical actions. In this situation, the gap is a complication of exogenous mechanical impact.
• Severe intestinal obstruction. Such a pathology causes many complications and needs qualified treatment.
• Closed intensive trauma of the stomach, abdomen, provoked by a fall, blow, accident. Depending on the degree of emergency, there may be different in nature and severity of associated injuries.
• The rectum is injured during non-traditional sexual intercourse, improper setting of a cleansing enema.
• Development in the organs of the digestive system of benign, malignant neoplasms.

Intestines

Important! It is impossible to independently determine the causes of the rupture; with such an injury, emergency qualified assistance is needed. .

Causes of colon rupture

A rupture in the colon can occur due to several factors:

• Fall from a great height as a result of negligence or suicide attempt.
• Explosive damage.
• Defeat as a result of a jump into the water flat from a great height.
• Rupture due to sports injury.

An experienced specialist will be able to easily determine the presence of anal fissures in a patient and prescribe the appropriate treatment. First of all, it is necessary to exclude the fistula of the rectum, which, unlike anal fissures, is not accompanied by spasm and such intense pain. Fistulas are also characterized by purulent discharge from the anus.

At the appointment, the doctor palpates the mucous membrane of the rectum, which, when in contact with the crack, is accompanied by pain. The specialist interviews the patient in order to get a complete picture of the signs of the disease.

The diagnosis is made after the following procedures:

• external examination, which makes it possible to determine the presence of an anal fissure;
• digital examination of the colon, during which the doctor probes the intestinal walls and determines the spasm of the sphincter;
• sigmoidoscopy, with which it is possible to carefully examine the intestinal mucosa at a distance of 30 cm from the anus;
• anoscopy, in which the examination of the final region of the colon is performed.

If there are suspicions of rectal ruptures, the doctor takes into account, first of all, painful sensations, the manifestations and intensity of which are determined in several ways.

As a treatment for serious injuries of the rectum, in most cases, a surgical method is chosen, which should include not only surgery, but also preoperative preparation, and postoperative methods of antibacterial and stimulating therapy.

The scale of surgical intervention directly depends on the nature and severity of the existing injuries and on the general condition of the patient. open wounds need surgical treatment. The method of suturing wounds is applied only in case of cracks that are punctured or cut and are not complicated by symptoms of peritonitis.

Resection of the large intestine is resorted to when there are extensive injuries or complete ruptures of the intestinal loop, accompanied by damage to the vessels.

Damage of an extraperitoneal nature is preliminarily sanitized and then sutured in several layers. If the rupture of the colon is accompanied by damage to the sphincter, then an unloading colostomy is applied, the wound and the distal region of the intestine are sanitized.

If minor cracks are found in a child, then conservative methods can be used for treatment, consisting in the use of a special diet aimed at combating existing stool disorders. In most cases, this approach is sufficient.

Causes

What is perforation? Why is it formed?

Intestinal perforation occurs when the wall of the organ is weakened and exposed to external negative influences. This disease is especially common in the presence of inflammatory diseases.

Reasons for perforation:

1. Inflammation. Acute or chronic inflammation of the intestinal tract, Crohn's disease or gastritis, can not only provoke weakening of the walls, but also lead to obstruction. In such a case, perforation can no longer be excluded.

Obstruction: Permanent paralysis of the intestinal muscles leads to narrowing of the lumen. Food slag accumulates in this place and is not transported further. The buildup of waste can become so large that the intestinal wall can't hold up and rupture occurs.

Diverticulitis. Diverticula obtained after birth are usually harmless, but the condition should not be triggered if the congenital anomaly persists. However, in some cases, they begin to become inflamed, which leads to a violation of swallowing and the movement of food through the intestines. As a result, it accumulates in one place, which further threatens to form a gap.

Toxic megacolon. This condition is characterized by a sharp increase in the size of the organ due to the rapid reproduction of cells.

Intestinal ulcers and tumors are a big risk, they weaken the walls of the intestine, causing perforation.

Operations. Surgical procedures increase the risk of intestinal perforation. Surgery on this organ can cause small cracks, which, if not properly treated, lead to large tears. Colonoscopy and sigmoidoscopy are extremely rare causes of this condition, but should not be ruled out.

Intestinal perforation can be caused by external influences. For example, if a person fell from a height, received stab, cut or lacerated wounds of the abdomen, had an accident in a car.

Rupture of the rectum in newborn babies most often occurs due to a delay in the development of certain systems and oxygen starvation of the fetus in the mother's womb. That is, perforation of the colon can be congenital.

Hereditary factors also play an important role. In 40% of cases, babies develop this condition if one of the parents has it.

Predisposing Risk Factors

It is important to note that the presence of a risk factor does not mean that a person will 100% acquire this condition. These conditions only increase the likelihood of bowel perforation.

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Risk factors:

• regular use of steroids, aspirin, or anti-inflammatory drugs;
• appendicitis;
• blunt abdominal trauma.

The absence of risk factors also does not mean that the patient will not get sick. It is always necessary to discuss their effect on the intestines, and what this may turn out to be with your doctor.

Species classification of damage

With bruises or contusions of the small intestine, there are:

• hematoma accumulations in the abdominal space;
• bloody accumulations under the intestinal mucosa.

With hidden injuries and wounds, the following can be injured:

• serous epithelium;
• mucous;
• the entire organ, up to the lumen.

Some types of damage.

Damage to the small intestine can be:

• through;
• fragmented;
• crossed;
• monofocal, that is, with an injury in one place;
• polyfocal, that is, with damage in several places;
• localized-isolated;
• multiple;
• accompanied;
• combined.

The small intestine may rupture completely or partially:

• across;
• in the longitudinal direction.

Intestinal loops can detach from the transverse colon:

• with circulatory disorders;
• without problems with the blood supply in the loop with the intestine.

According to the degree of damage to the intestines, 3 groups are distinguished:

1. Minor injuries such as excoriation, cracking, tearing of the wall or mucosa. In these cases, treatment is not necessary, the wounds heal quickly.
2. Moderate injuries, for example, extraperitoneal stratification of tissues, injury to the intestine without damage to the abdominal tissues.
3. Severe injuries with violation of the integrity of the abdominal tissues and neighboring organs. Often complicated by infection of the peritoneal space and / or accumulation of loose fibrous connective tissue between organs.

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Disease prevention

To prevent the development of such a painful disease, doctors recommend following a few simple rules:

1. hygiene measures. After visiting the toilet, wash the anus area with cool water.
2. Proper nutrition. Eliminate the intake of semi-finished products, fast foods, excessively fatty foods. Avoid spicy and fried foods. Alcohol should not be abused.
3. Proper use of the toilet. It is not recommended to sit on the toilet for a long time. If after 2-3 minutes the defecation process has not occurred, postpone this event. Get up, walk around, and try again in a few minutes.
4. Empty your bowels promptly. Go to the toilet at the first call. Do not delay the process of defecation.
5. Go in for sports. Recommended: walking, running, yoga, swimming. This advice is especially important for those people who are forced to sit for a long time.

Remember that you can defeat almost any ailment if you consult a doctor in a timely manner and fully comply with the treatment prescribed by him.

Rectal disease in women and men is one of the most common and very delicate topics that are relevant today. Perhaps this is because many are embarrassed to seek help from a specialist.

The worst disease that can affect the rectum is cancer. Like other types of tumors, it is characterized by an asymptomatic course.

Therefore, it is imperative to pay attention to any changes in the rectum.

Treatment Methods

Surgical intervention is necessary.

For any type of injury to the small intestine and adjacent abdominal organs, an appropriate way to eliminate the problem is early surgical intervention. In most cases, patients with intestinal damage come to the doctor in a state of deep shock. Before the operation, the doctor takes a number of necessary measures:

• antishock therapy;
• diagnosis of pathology and its causes.

The operation, predominantly midline laparotomy, is performed under endotracheal anesthesia using relaxants. When examining the abdominal cavity after the incision:

• drain the damaged area from blood using an electric suction;
• find the source of blood loss and stop it;
• if necessary, the contents of the small intestine are removed by electric suction.

Detection of parts of the intestine with a violation of integrity is carried out by a thorough examination of each of its departments. The reference point is swelling due to the onset of inflammation and fibrin deposition. The tear area is covered with a large number of gauze napkins. The intestinal loop should be brought to the abdominal wall, and then the revision of the intestine and nearby organs should be continued to determine the extent of the damage.

Open type wounds lead to damage to the intestine in several places. The tissues are torn at the same time in pairs, neighboring organs are injured. Therefore, the examination should be as thorough as possible. After examining the intestines, large swabs are inserted into the left and right lateral canals, as well as into the small pelvis, to suck out exudate and protect the peritoneum from infection. General tactical principles in intestinal surgery:

• stopping bleeding;
• prevention and elimination of infection in the peritoneum, which spreads when intestinal contents enter the cavity;
• normalization of intestinal patency;
• washing with saline NaCl with furacillin;
• drainage of the abdominal cavity;
• installation of drains for the introduction of antibacterial drugs (for taking preventive measures peritonitis).

Operation types:

• Suturing an intestinal rupture with excision of destroyed tissues and damaged edges of doubtful viability.
• Resection of part of the intestine in large numbers injuries, large-scale ruptures of the intestinal wall or separation of the intestine from the duplication of the peritoneum.

Choice of type, volume surgical method, as well as its phasing, are determined by the type and scale of the existing injuries and the general well-being of the patient.

Mortality in case of damage to the small intestine depends on the timeliness of detection of injuries. Peritonitis, which develops as a result of late admission of the patient with a late operation, is the main cause of death. Also, death is possible due to the failure of the sutures of the intestinal anastomosis, with a combination of damage to the small intestine with severe trauma to other organs of the peritoneum and the musculoskeletal system.

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Methods of treatment of ruptures of the large intestine

In the treatment of intestinal injuries, most often it is not possible without a surgical method. It includes not only the operation, but also the preparation before it is carried out. Also, after the operation, they resort to antibacterial testing and methods of stimulating therapy. The level of surgical intervention is determined based on the general condition of the patient and the severity of his disease. Open injuries cannot be healed without surgery. Wounds are sutured in the presence of cut or stab cracks without symptoms of inflammation of the peritoneum. Removal of a part of the organ is resorted to with extensive disruption of the organ or a complete rupture of the intestinal loop, accompanied by damage to the vessels.

Extra-abdominal injuries first of all undergo sanitation, after which they are sutured in several layers. If the sphincter is damaged in case of intestinal rupture, an unloading colostomy is applied, then the wound and the distal intestinal region are sanitized. Upon detection small cracks use conservative methods of treatment with the use of a diet. So, doctors are struggling with stool disorders. Most often, this method is sufficient to achieve an effective result.

Treatment

The most effective treatment for rectal rupture is surgery. At the same time, doctors can save a person from an infection and a focus of a ruptured intestine.

The favorable outcome of the operation is influenced by the preoperative preparation of the patient, aimed at stabilizing his general condition. Before surgery, it is necessary to normalize blood circulation, respiration, reduce intoxication, and correct metabolic processes.

To avoid oligemia, drip intravenous infusion of salt solutions is used, and vascular insufficiency is neutralized by drip injection of 30-50 mg of prednisolone.

If we are talking about an emergency operation in the presence of other severe injuries, such manipulations are carried out in parallel with the surgical intervention. The nature of interventions depends on the degree of damage, concomitant injuries of nearby organs and is performed using general anesthesia.

Manipulation requires wide access, which often makes it possible to see minor lesions that were not noticed before, but require treatment. This access is a median incision, through which the abdominal cavity is drained, and then the choice of manipulations is carried out.

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The intestinal walls are peritonized if minor hematomas are found, and if there are significant damage or microperforation of the walls, the hole is sutured. With paired holes located at a distance of 10 cm or more from each other, their stitching with excision of uneven edges is shown.

At through holes colon, located close to each other, and the integrity of the mesentery, a wedge-shaped resection of the intestine is performed. Otherwise, if there are many holes, they are located close to each other and the mesentery is torn off, they resort to resection of the colon with end-to-end anastomosis.

Wounds with damage to the colon are usually sutured with a two-row interrupted suture with the formation of an unloading double-barreled colostomy. After that, a gas outlet tube wrapped in a napkin with Vishnevsky's ointment is inserted into the intestine, and the ischiorectal space is irrigated with solutions of antibiotics and antiseptics.

The favorable outcome of the operation depends on how quickly the victim was taken to a medical facility.

Therapy of minor injuries of the walls of the colon is carried out by means of drug treatment. If such therapy does not give positive results, an operation is prescribed. Such actions include not only surgical intervention, but also rehabilitation treatment.

Injury to the intestine is the main indication for surgical intervention. The operation is carried out regardless of where the rupture occurred.

During the surgical intervention, the doctor stitches the tissues with special threads, which subsequently will not need to be removed. During the operation, the specialist makes every effort to preserve the walls of the intestine.

In the treatment of anal fissures, they are guided by the achievement of results in terms of normalizing the stool, reducing pain, healing the affected area, and also reducing the increased sphincter tone in this case. Two treatment options are used, surgical treatment and non-surgical treatment.

Recovery stage after a break and diet

After identifying the cause of the damage and eliminating it, the patient remains in the hospital under the supervision of doctors for another one to two weeks. At this time, the doctor advises to observe bed rest, avoid heavy physical exertion and weight lifting.

The main task of the recovery phase is to establish peristalsis of the intestinal canal, so you must adhere to a strict diet.

The diet can include grated food in the form of vegetable soups, cereals, lean meat. You should also consume dairy products. It is strictly forbidden to eat fatty, spicy, fried, smoked foods.

After the hospital, the doctor does not allow hot baths. by the most ideal option considered a warm shower. Light massage should be performed daily. This involves massaging the gastric area with light and stroking movements.

There is also drug therapy. The patient is prescribed antibiotics. This will avoid complications in the form of inflammation and intoxication.

Some experts use an unusual method of quickly recovering the intestinal tract after surgery in the form of acupuncture. Manipulations with needles help restore the functioning of the nervous system, normalize sleep.

With extra-abdominal pathologies, sanitation is performed using antiseptic and disinfectants. If cracks are observed in the anal region, then conservative therapy is performed. It involves the use of suppositories, ointments and tablets for oral administration.

If constipation is observed, then the patient is prescribed a light laxative medication. This includes candles or tablets of plant origin in the form of glycerin, sea buckthorn suppositories, Dufalac syrup, Fitolax, Gutallax. It is also recommended to use prunes, raisins, boiled beets, baked apples and apricots.

Clinic and diagnostics

The symptoms of damage to the small intestine are varied and are determined by the nature, location, severity of injury, compatibility with injuries of neighboring abdominal organs and areas of the body (skull, spine, chest, pelvis). Symptoms worsen over time, becoming more pronounced.

One of the signs is the desire to be in the fetal position.

General symptoms:

• The desire of the victim to constantly lie in the fetal position, since in other positions the pain syndrome intensifies.
• In the first 2 hours, there are signs of acute abdomen syndrome, peritonitis with diffuse pains and muscular defense of the abdominal wall.
• Dry mouth, tongue furred.
• Vomiting of blood when the injury has affected the proximal bowel.
• Immediately the pulse slows down, then quickens with a simultaneous drop in blood pressure.
• Fever, fever with manifestations of leukocytosis.

If injury to the intestine is accompanied by hematomas of the walls, bruises or small ruptures of its compartments without severe bleeding, pain shock and other symptoms appear only when the injury itself. In the future, there comes a "light" period without severe symptoms lasting up to several hours. The severity of the resulting intestinal injury determines the direction of the dynamics, which can take a positive direction. More often, negative symptoms appear, accompanying the aggravation of the pathology.

In case of injury to the abdomen closed type the first 60-120 minutes gradually appear signs characteristic of contusions of hollow and / or organs with one parenchyma. Over time, the symptoms of slowly developing peritonitis increase. In this case, it is difficult to diagnose the detachment of the intestine from the duplication of the peritoneum, which is not always accompanied by bleeding into the peritoneum.

Over time, after a "light" asymptomatic period, peritoneal signs gradually develop, lasting up to 7 days. The formation of necrotic tissues occurs, if blood circulation was disturbed due to ruptures of the peritoneal duplication, hematomas appeared, and vascular thrombosis spread in the intestine.

Symptoms of damage to the small intestine are variable. The symptoms improve or worsen over time since the injury. Due to the state of shock, rapid blood loss, it is difficult to diagnose the nature and extent of the injury. This leads to diagnostic errors and belated operations. To diagnose possible damage to the intestines and establish the severity of injuries, in addition to examination, a number of additional tests are needed:

Ultrasound echo diagnostics is necessary to visualize the scale of damage.

• Finger-rectal examination to detect relaxation or gaping of the sphincter. The method can be used to diagnose paralytic ileus, protrusion of the peritoneal pocket with accumulations and changes in blood with exudate that accumulate in the pelvic region.
• X-ray examination to detect free gas under the diaphragm, which will indicate a rupture of the hollow organ.
• Ultrasound echo diagnostics to visualize the scale of damage, the degree of involvement of other organs and tissues of the peritoneum.
• Minimally invasive examinations, such as laparocentesis (with sampling of pathological fluid), laparoscopy (examination of the peritoneum using the optical system of the laparoscope through small holes in skin). The methods allow obtaining the accuracy of diagnostic results up to 92-99.5%. Laparoscopy refers to extreme methods, therefore it is used in doubtful cases in order to clarify the preliminary diagnosis.

Open injuries are easier to diagnose than closed ones. To improve the accuracy of diagnosis and in doubtful cases, when the wounds are "blind", it is recommended to use a contrast x-ray - vulnerography.

The intestine is an important part of the alimentary canal, starting from the stomach and ending at the anus. The intestine in the human body performs one of the most important roles for functioning - digestion of food, absorbing useful substances from it, and removing harmful ones - toxins and toxins. The article deals with a serious pathology, such as intestinal rupture.

Why does the break happen?

Rupture is the most dangerous disease for human life and health. It can happen due to:

• closed blunt abdominal trauma. The disease usually appears when a large force is struck, for example, in a traffic accident or a patient falling from a great height. With such injuries, the rectum can rupture across or in single sections.
• great tension of organs and high intra-abdominal pressure by women during the birth process.
• strong compression of the lower parts of the body.
• during unskilled medical manipulations: colonoscopy, enemas or endoscopy.
• receiving a sharp blow with a heavy object in the abdominal cavity or abdomen.
• during sexual violence in the anus. According to statistics, almost 40% of the victims are diagnosed with the presence of this disease.

The human intestine is able to burst when it is overfilled due to constant constipation, hernia, adhesions and tumors in this organ.

No matter what factors caused the intestinal rupture, with this disease, the patient needs urgent health care and hospitalization. Eliminate the disease with the help of a surgical operation.

Symptoms of intestinal rupture

If a person has a rupture of the large or small intestine, he will have to endure unpleasant and very painful sensations. The nature of the pain varies slightly depending on the type of injury. Having received a closed injury, the patient experiences a sharp severe pain in the lower abdomen, the pain is aggravated by examination by palpation. The anterior abdominal wall is excessively tense. With an illness, the pulse and heartbeat increase significantly, the mucous membranes and tongue of the victim become dry, peristaltic noises in the abdominal cavity are not heard.

With injuries associated with complete separation of the intestine from the mesentery or its damage, the patient often suffers intra-abdominal bleeding, accompanied by low blood pressure, tachycordia, pale skin, lethargy and restlessness. To accurately establish the diagnosis, the victim undergoes an X-ray examination, and if the diagnosis is confirmed, an emergency laparotomy or laparoscopic operation is performed.

Any damage or rupture in the intestine is accompanied by bloating, due to excessive air entering the peritoneum. In addition, a person experiences pain during bowel movements, which can be felt after a few hours. When the intestines rupture, the patient in almost all cases has bloody discharge from the anus, accompanied by a sharp burning pain. The pain can be so severe that the person cannot bear it and loses consciousness. Severe trauma can cause intestinal loops to protrude from the anus, which causes a sharp rise in body temperature.

When open damage colon, the patient is provided with emergency surgical care, which consists in urgent treatment of the wound with an audit of the abdominal organs to determine the degree of damage.

Treatment

As previously mentioned, the main method of treatment for rupture of the rectum is surgical intervention. The patient undergoes both surgery and rehabilitation therapy. A rupture or fissure of the intestine is eliminated by suturing only after the appearance of stab or cut wounds, provided that there is no suppuration and inflammation.

With 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 associated organ damage.

If the intestine has received minor damage, the surgeon simply sutures the damaged area, but if serious damage has occurred, the affected area of ​​the intestine is removed, and then the intestine is sutured in several layers. Fully integrity of the rectum is able to recover after at least 3 months.

Rehabilitation after illness

After an illness, like a rupture in the intestines, the patient must adhere to special rules and diets. During the first two days after surgery, the patient is forbidden to eat, for the speedy healing of the sutures. In water during this period the patient is not limited. From the third day, doctors allow the intake of non-solid food, which must be divided into 7-8 small portions. After a week, you can reduce the number of meals and slightly increase portions. From the 7th to the 14th day, it is allowed to eat 3-4 times, adding low-fat soups, steamed dishes and boiled meat.

The patient's stool during the rehabilitation period should not be hard, so it is possible to use laxatives or self-prepared folk remedies.

In conclusion, it should be noted that intestinal rupture is a life-threatening and health-threatening disease, so untimely receipt of qualified assistance can lead to irreversible consequences, including death.