How Do I Treat a Perforated Bowel?

The small intestine, colon, and mesentery are widely distributed in the abdominal cavity, large in volume, relatively superficial, and without bone protection. Therefore, they are easily affected by penetrating or closing injuries in the abdomen. Open injuries can occur anywhere and are often multiple. The site of a closed injury varies according to the mechanism.

Basic Information

English name

intestinal perforation

Visiting department

Anorectal

Common causes

Violence directly hits the center of the abdomen, and is directly hit and crushed by external forces from the front

Common symptoms

Abdominal pain, bloating and bowel sounds disappear

Causes of intestinal perforation

1. When the violence directly hits the center of the abdomen, the middle part of the small intestine is easily squeezed on the spine and ruptured (such as falling from a high place or suddenly decelerating) often causing damage to relatively fixed intestinal segments such as the initial jejunum and the terminal ileum. When violence is suddenly applied to the fluid-filled small intestine or the explosion causes a sudden increase in intraluminal pressure, these areas are prone to rupture or even fracture. Patients with abdominal wall hernias have a greater chance of rupture of the small intestine during blunt injury than normal.

2. In blunt injuries, ruptures caused by direct impact and crushing from the front by external forces are mostly the superficial transverse colon and sigmoid colon. The abdomen and waist suffer violence, which can hurt the ascending or descending colon due to compression. Swelling caused by the sudden rise in the intestinal cavity is easy to occur in the cecum section.

Clinical manifestations of intestinal perforation

Mainly manifested by bacterial peritonitis. Complicated injuries are more common and are easily masked by other symptoms. Spine or pelvic injury itself can cause abdominal pain, bloating, and bowel sounds to disappear. If the bowel ruptures at the same time, the latter is easily ignored.

Bowel perforation diagnosis

No difficulty in diagnosis. When the distal small intestine is ruptured, due to the small chemical irritation of the contents, the symptoms and signs develop slowly, which may cause delay in diagnosis. Spine or pelvic injury itself can cause abdominal pain, bloating, and bowel sounds to disappear. If the bowel ruptures at the same time, the latter is easily ignored. Laparotomy or lavage can help define the diagnosis.

Intestinal perforation treatment

1. During the operation, the entire intestine and mesentery should be systematically and carefully explored. Even if the mesangial hematoma is not large, it should be opened to prevent small perforations from being missed. Neat lacerations can be sutured with silk threads for two lateral inversions. Debridement should be performed in patients with marginal tissue crushing and impaired blood flow (such as high-speed shrapnel injury), and the wound margin should be confirmed before good suture.

2. Enterectomy should be performed in the following cases:

(1) If the defect is too large or a long vertical laceration, direct suture is expected to cause intestinal stenosis

(2) more ruptures are concentrated on a small section of the intestine;

(3) severe intestinal contusion and impaired blood flow;

(4) there is a large hematoma in the intestinal wall or mesentery;

(5) Severe contusion or rupture of the mesentery, or blood flow disorder caused by avulsion between the mesentery and the intestine.

3. Dealing with mesangial injury should be very detailed, not only to properly stop bleeding, but also to avoid suture of unaffected blood vessels, mesangial large blood vessels are damaged, and arteries can be repaired as much as possible. Syndrome. The collateral circulation of the vein is relatively rich, and the chance of ischemic necrosis after ligation is reduced, but it should also be performed with caution. Holes in the mesangium should be repaired to prevent internal hernias.

4. During the operation, the leaked intestinal contents should be completely removed and rinsed with a large amount of physiological saline. A drainage tube is placed in the pelvis to prevent the formation of an abscess.