How to check for intestinal perforation

Perforation sounds like a very serious disease. In fact, when an organ is perforated, it is not a large hole, but some cracks in the organ due to viral infection or external force. Generally speaking, if an organ is perforated, it is invisible to the naked eye and we can only go to the hospital for examination. So, do you know how to check for intestinal perforation?

Causes

1. When there is a violent direct impact on the center of the abdomen, the middle section of the small intestine is easily squeezed against the spine and ruptured (such as falling from a height or sudden deceleration), which often causes damage to relatively fixed intestinal segments such as the beginning of the jejunum and the terminal ileum. When violence is suddenly applied to the fluid-filled small intestine or an explosion causes a sudden increase in intraluminal pressure, rupture or even breakage may easily occur in these areas. Patients with abdominal wall hernia are more likely to suffer small intestinal rupture during blunt trauma than normal people.

2. In blunt trauma, ruptures caused by direct impact or crushing from the front are mostly in the more superficial transverse colon and sigmoid colon. Violence to the abdomen and waist may injure the ascending colon or descending colon. The sudden rise in the intestinal cavity caused by squeezing is prone to rupture in the cecum.

Clinical manifestations

The main manifestation is bacterial peritonitis. Combined injuries are more common and can easily be masked by other symptoms. Spinal or pelvic injury itself can cause abdominal pain, abdominal distension and loss of bowel sounds, which can be easily overlooked if intestinal rupture occurs at the same time.

diagnosis

Diagnosis is usually not difficult. When the distal small intestine ruptures, the symptoms and signs develop slowly because the contents are less chemically irritating, which may cause a delay in diagnosis. Spinal or pelvic injury itself can cause abdominal pain, abdominal distension and loss of bowel sounds, which can be easily overlooked if intestinal rupture occurs at the same time. Abdominal puncture or lavage can help confirm the diagnosis.

treat

1. During the operation, the entire intestinal segment and mesentery should be systematically and carefully explored. Even if the hematoma at the edge of the mesentery is not large, it should be opened for inspection to avoid missing small perforations. For lacerations with neat edges, two layers of horizontal inward sutures can be made with silk thread. In cases where there is crushing of the marginal tissue and obstruction of blood supply (such as high-speed shrapnel injuries), debridement should be performed, and the wound edge should be sutured only after confirming that there is good blood supply.

2. Bowel resection should be performed in the following situations:

(1) If the defect is too large or the longitudinal laceration is long, direct suture may cause intestinal stenosis

(2) Multiple ruptures are concentrated in a small section of the intestine;

(3) Severe intestinal crush and blood flow obstruction;

(4) Large hematoma in the intestinal wall or at the mesenteric edge;

(5) Severe contusion or rupture of the mesentery, or avulsion between the mesentery and the intestine, leading to blood flow obstruction.

3. The treatment of mesangial injuries should be very meticulous. It is necessary to properly stop bleeding and avoid suturing uninvolved blood vessels. For large mesangial blood vessel injuries, the arteries should be repaired as much as possible if they can be repaired. A few require anastomosis and reconstruction to avoid extensive resection of the small intestine that may cause short bowel syndrome. The collateral circulation of veins is relatively rich, and the chance of ischemic necrosis after ligation is reduced, but it should also be performed with caution. The holes in the mesentery should be repaired to prevent internal hernia.

4. During the operation, the leaked intestinal contents must be thoroughly removed and flushed with plenty of saline. A pelvic drain is placed to prevent abscess formation.