Colon damage. Intestinal injuries Colon rupture consequences

Injuries to the colon can result from blunt and acute trauma, as well as exposure to chemicals. Rupture of the rectum and colon can occur from a sudden increase in intraintestinal pressure, during intestinal lavage, enema, careless use of technical means, etc. Colon injuries are most often observed in wartime. Basically, these are gunshot wounds (bullet and shrapnel), as well as injuries received from compression of the abdominal cavity, falls from a height or strong impacts under the influence of a blast wave.

In peacetime, injuries to the colon most often occur as a result of blunt trauma during car accidents, certain medical procedures (enemas, endoscopy), operations on neighboring organs, or endoscopic polypectomy. Rectal ruptures have been described during sexual intercourse or masturbation.

Chemical burns of the rectum and colon occur, as a rule, as a result of the introduction into the rectum by mistake of the medical staff or the patient himself during an enema instead of water of any chemically active substance (ammonium, mercuric chloride, formaldehyde, etc.).

Injuries to the colon can be either extra- or intraperitoneal. An important circumstance is the presence or absence of damage to the anal sphincter.

In addition to direct injury to the wall of the colon, partial rupture or injury to its mesentery is possible without direct impact on the intestinal wall.

Like any injury, injuries to the colon can be open and closed, single and multiple, combined and combined.

Characteristic of all types of damage to the colon is the rapid development of inflammatory complications. With a penetrating wound it is peritonitis, with an extraperitoneal wound it is phlegmon of the subcutaneous or perirectal tissue and perineum.

With chemical burns of the colon, the mucous membrane may become necrotic over a significant extent, and when moving to other layers of the intestinal wall, phlegmon or multiple perforations with diffuse peritonitis may develop.

In case of fractures of the pelvic bones, damage to the rectum is observed in combination with damage to neighboring organs (bladder, uterus, vagina, prostate). Therefore, in such a situation, it is necessary to take an x-ray of the pelvic bones, and also examine not only the rectum, but also these organs.

In cases of combined injuries of the colon, rupture and injury to the small intestine, liver, stomach, kidneys, spleen, and hematoma of the retroperitoneal tissue may simultaneously be observed. In case of combined injuries, combined or isolated injuries of the colon occur against the background of damage to the diaphragm and chest organs.

Injury to the rectum by foreign bodies is usually observed in childhood, but also occurs among adults. Emergency situations arise when rapid removal of a foreign body is required to eliminate developed complications. Foreign bodies can enter the rectum due to injury, penetrate into the intestinal lumen during medical procedures, and form in the intestine (fecal stones) when the evacuation of intestinal contents is impaired. Sometimes foreign bodies are inserted into the anus as a result of criminal or psychopathic acts.

Injuries to the rectum from both sharp and blunt objects are most often observed in peacetime. Most often this is associated with a fall with the crotch onto a protruding hard object. A wounding object can damage the intestinal wall by entering directly through the anus or through the skin of the perineum. In this case, patients feel severe pain in the anus and perineum, and severe bleeding may occur. Due to severe pain, there may be a short-term loss of consciousness and even painful shock.

Diagnostics

Diagnosis of intraperitoneal injury to the colon, especially in the case of perforation, is based on studying the mechanism of injury and the presence of peritoneal phenomena. X-rays reveal free gas in the abdominal cavity, and later free fluid. Blood tests show leukocytosis, a shift to the left in the white blood count, and sometimes a decrease in hemoglobin. Diagnosis of intraperitoneal injury to the colon is often difficult. The complex of diagnostic measures for gunshot wounds of the abdomen consists of successively replacing each other stages - general clinical methods, primary surgical treatment of wounds, laparoscopic examination.

The diagnosis of extraperitoneal injuries to the ascending, descending and rectum also presents certain difficulties, since external damage may be minor, and local and general symptoms of intestinal damage may not clearly appear for some time. Careful collection of anamnesis, study of the mechanism of injury, careful examination of the patient, identification of a fracture of the pelvic bones contribute to the correct diagnosis. The presence of wounds in the perineum and buttocks, especially when intestinal contents come from deep within the wounds, serves as the basis for the diagnosis of rectal damage. The latter is also damaged by bone fragments during a pelvic fracture. For a more detailed diagnosis of extraperitoneal injury to the rectum, digital examination and anoscopy using an anoscope or a rectal speculum are required.

These studies can detect defects in the rectal wall and the presence of blood in its lumen.

Differential diagnosis of intraperitoneal wounds and ruptures should be carried out with injuries of the lumbar region, perineum and retroperitoneal hematomas that do not penetrate the intestine. Some difficulties are possible in recognizing combined and isolated injuries of the genitourinary organs. Manual examination through the vagina in women and special urological studies (urethro- and cystography) often help establish the correct diagnosis.

Treatment

Treatment is always surgical. Injuries to the colon and operations for these injuries pose a great risk to the patient's life. Therefore, comprehensive treatment is necessary, starting with preoperative preparation aimed at the prevention and treatment of septic and hemorrhagic shock, including subsequent transfusion, antibacterial and stimulating therapy.

The extent of the operation is determined by the nature of the intestinal damage and the general condition of the patient. In case of open injury, primary surgical treatment of the wound is necessary, followed by a decision on the method of treating the wound or other intestinal injury. Defects in the intestinal wall are sutured only for puncture and incised wounds in the early stages after injury in the absence of peritonitis and purulent inflammation along the skin wound. All this is performed under the cover of a colostomy.

In case of intraperitoneal injuries, the damaged section of the intestine is most often brought out or resected without anastomosis; a colostomy or colo- and ileostomy is formed when the damaged right half of the colon is removed. Continuity of the colon is restored after 2-4 months. after the inflammatory process subsides.

Often damage to the colon is combined with damage to other abdominal organs (kidneys, liver, spleen, stomach). Injuries to the colon can be combined with damage to the chest. Therefore, surgical intervention should first of all provide good access to the damaged organ, a sufficient and complete overview of the abdominal cavity, taking into account the reasons that complicate access to some parts of the colon. All these requirements are met by median laparotomy, which is most often used for gunshot wounds of the colon.

When revising the abdominal cavity, special attention should be paid to damage to other organs, to sources of bleeding and to the extraperitoneal parts of the colon, so that hematomas and other injuries do not go unnoticed.

Resection of the intestine is performed for extensive wounds, partial or complete ruptures of the intestinal loop with damage to the vessels of the mesentery. This operation is performed mainly for damage to the transverse, descending and sigmoid colon.

In case of damage to the right half of the colon, resection using the hemicolectomy type was performed quite rarely - the extended operation was very difficult to tolerate by the wounded. However, recent reports based on the experience of treating the wounded in Afghanistan and Chechnya indicate a fairly frequent use of this intervention with quite satisfactory results.

In case of extraperitoneal injuries of the rectum, the wound is carefully sanitized and it is sutured layer by layer from the lumen side. If the external sphincter is damaged and there is an extensive wound of the perineum, then it is necessary to apply an unloading colostomy, sanitize the wound and the distal part of the intestine, and drain them with the expectation of using a delayed suture.

Retroperitoneal injuries of the colon are also treated in two stages: first, the damaged part is disconnected by applying a separate colostomy or ileostomy, and after healing of the damaged intestine or the formation of a fistula, reconstructive operations are performed. In some cases, the issue of applying a colostomy or ileostomy is controversial. Some surgeons consider it possible to do without disconnecting the intestine for small single injuries of both the colon and rectum.

Absolute indications for intestinal disconnection are:

• various types of intraperitoneal penetrating injury to the rectal wall;
• various types of extraperitoneal penetrating damage to the rectal wall above the level of the levator.

Make an appointment

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 a cause of rupture

When a strong and sudden mechanical impact occurs on the anterior abdominal wall of the body, intestinal rupture occurs. It must be said that such a situation ends in the death of the victim if he does not have time to provide professional assistance in time. Most often, intestinal rupture occurs during an accident. When the vehicle suddenly stops moving due to a collision with an obstacle, the passenger and driver continue to move forward by inertia. This results in a strong impact with the steering wheel, your own knees or the dashboard. In isolated cases, there may be an impact from a seat belt that was not fastened correctly. This sometimes occurs in child seats. If a passenger or driver was not wearing a seat belt, they could be thrown through the windshield during a car accident. This will result in an even stronger impact.

You can get a similar injury if you are a pedestrian and get hit by a car.

Regardless of the case, the basis of pathogenesis can be called a sharp blow to the abdominal area, 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 sharply, the gas pressure will increase, which significantly increases the risk of intestinal rupture.

Since the large intestine is constantly in some movement, its damage is very rare. More often you may encounter 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 - may also be affected.

Abdominal adhesions

The greatest risk of encountering a rupture of the intestine (large and/or small) is in the presence of adhesions in the abdominal cavity. Since adhesions can incredibly tightly fix the intestinal walls, its mobility decreases several times. Sometimes you may encounter situations where the adhesion is too tightly attached directly to the intestinal wall. When it begins to separate, it can rupture not only the intestine, but also the area that is located nearby.

Adhesions in the abdominal cavity may appear due to an inflammatory process 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 makes it possible to set boundaries for the inflammatory process and prevent it from spreading further. When the inflammation is advanced, effusion begins to appear. It contains a huge amount of fibrin and other various substances. Fibrin begins to glue the intestinal walls together and prevents the inflammatory process from spreading to other areas of the small or large intestine. Adhesions are why these formations will remain with a person for life. The risk of intestinal rupture is increased several times by the presence of tumors, compression by a hernial sac, or overfilling with large amounts of feces or gases.

Intestinal obstruction as a cause of intestinal rupture

If a person suffers from intestinal obstruction, then due to severe obstruction of the lumen of the immediate distal areas, expansion occurs due to the accumulation of feces, gases, and liquid. A similar situation can arise due to intestinal volvulus and prolonged stool retention. The colon swells to such a size that even a minor mechanical impact can cause rupture.

The risk of rupture increases if a person suffers from Crohn's disease, colitis or ulcerative colitis. The intestinal wall becomes weaker, making it very vulnerable.

Iatrogenesis

Ruptures may occur due to intraluminal endoscopic intervention in the colon. The complication most often occurs due to incorrect and abrupt insertion of the colonoscope. The risk increases if the patient suffers from serious bowel disease. If all safety rules are followed during an endoscopic examination, the risk of injury is minimal.

Perversions of a sexual nature

If there is a voluntary or forced insertion of a foreign object into the anus, this can cause a rupture of the sigmoid colon. The problem has become increasingly common in recent years. 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 pressure sore of the wall, and then perforation.

Other reasons

Also, rupture of the intestines and other abdominal organs can occur in the following situations:

• Falling from a great height due to carelessness or attempted suicide.
• A person is killed by a blast wave.
• Due to jumping into water from deep water.
• Intestinal rupture may be associated with a sports injury.
• Gunshot or knife wound.

Signs of injury

All symptoms that arise as a result of rupture of the small or large intestine have one common name - acute abdomen. intestines look like this:

1. Severe sharp pain appears in the lower abdomen. The painful sensations are stable and are not eliminated by painkillers.
2. The abdominal muscles are in constant tension. During palpation, painful spasms can be felt.
3. If there is a rupture of the upper part of the intestine, then there is masses of blood in the stool.
4. There is a bitterness in the mouth.
5. There is a frequent urge to defecate of a false nature.
6. A strong pulsation is felt at the site of the rupture.

If these symptoms appear, you should immediately consult a doctor, since the consequences of intestinal rupture can be very dire.

Diagnosis of the disease

Sigmoidoscopy and colonoscopy cannot be used to diagnose intestinal rupture. In this situation, fluoroscopy is considered the only acceptable examination method. To make a diagnosis, you can additionally do an ultrasound of the abdominal cavity. The formation of too much gas will also indicate serious damage to the intestines. Disorders can be varied - rupture of the intestinal 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 rods (the normal value is 2, and the acceptable value is 45), if the leukocytes are significantly reduced, then you should immediately begin examining the patient’s intestinal tract. If the analysis shows that there are more than 20 nuclear bacilli in the blood, then we can say with 90% confidence that intestinal perforation. In this case, blood in the stool is often observed.

Treatment

The main stage in the treatment of rupture of the small or large intestine, or other injuries of a through nature, is surgical intervention. 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 in this case only dissection will be sufficient. Doctors will clean the fistula canal and disinfect it. Then you need to thoroughly rinse the cavities located next to 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 the patient does not experience any complications after surgery, he is discharged from the hospital the very next day.

If the intestine ruptures into the abdominal cavity, an abscess (peritonitis) may occur. In this case, it is necessary to rinse 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 cannot be avoided.

If more than 30% of the intestine has been damaged, then perform it. As a result, the length of the affected section decreases. After resection, the digestibility of food decreases several times. In some patients, within half an hour after they eat, the urge to defecate appears.

If complications arise due to intestinal rupture (inflammation of the pancreas, liver), a person must permanently exclude fatty, fried and spicy foods from his diet. If the functioning of the pancreas has been disrupted, then it is necessary to artificially regulate blood sugar levels.

Closed intestinal injuries occur when there is a strong blow to the stomach with a blunt, hard object. The most common cause of intestinal damage is street and railway trauma. Occasionally, cases of intestinal rupture have been observed during heavy lifting and even during severe straining. The latter is possible only with a pathological condition of the intestine. In wartime, closed intestinal injuries caused by an air or water blast wave occur. The small intestine is damaged much more often than the large intestine, mainly its initial and final segments.

There are crushing, rupture of the intestine, separation of the intestine from the mesentery and bursting of the intestinal loop. The intestine is crushed between the damaging object and the spine or ilium. The intestine bursts when there is a strong increase in pressure in a closed loop of the intestine. Usually the intestine is damaged throughout the entire thickness of the intestinal wall with the opening of the cavity, i.e., intestinal rupture occurs. Less often, with weaker violence, only individual layers of the intestinal wall are damaged without opening the cavity, i.e., a tear or bruise of the intestine occurs. Bruises and tears in the intestine may result in healing or subsequent perforation. The integrity of the intestine can also be damaged by a sharp foreign body from the inside.

When intestinal ruptures, the initial symptoms of shock, which often obscure the actual state of affairs, are quickly followed by symptoms of peritonitis, which develops as a result of the entry of intestinal contents into the abdominal cavity. Nausea, vomiting, tension in the abdominal muscles, the Shchetkin-Blumberg symptom appear, breathing becomes shallow, and the pulse quickens. In men, the testicles are pulled towards the openings of the inguinal canals. The decisive symptom of rupture is the presence of free gas in the peritoneal cavity. Gas is detected by tapping the area of ​​the liver, where a band of tympanic sound is detected against the background of hepatic dullness, or by x-ray. This symptom is not constant and is rarely observed. If, simultaneously with a rupture of the intestine, larger vessels of the mesentery are damaged, the phenomena of peritonitis are preceded by the phenomena of internal bleeding.

Separation of the intestine from the mesentery without through damage to the intestinal wall gives a picture of internal bleeding without symptoms of peritonitis. Peritonitis occurs later, after necrosis of the severed section of intestine and subsequent perforation, which often occurs several days later.

Urgent laparotomy (also in doubtful cases) and suturing of the wound in the intestine are indicated.

Open damage or wounds to the intestines are caused by bladed weapons, bullets or fragments of explosive shells. In wartime, intestinal injuries are very common. The symptoms are the same as for closed injuries, i.e., at first the phenomena of shock are observed (not always) against the background of more or less internal bleeding, and then quickly, already in the first hours, the phenomena of developing peritonitis. Damage to the intestines is indicated by the early appearance of protective tension in the abdominal muscles, the Shchetkin-Blumberg symptom, shallow abdominal breathing, rapidly developing bloating, the presence of free fluid in the abdominal cavity, pallor, and the restless, serious condition of the patient. The latter may be missing.

In making a diagnosis for gunshot wounds of the abdomen, the location of the entrance wound plays a role, and in the case of through wounds, the exit wound opening. A mentally drawn line of the wound channel indicates damaged cavitary organs. It is prohibited to examine the wound with a probe or finger. The penetrating nature of a stab or cut wound will also be determined during the treatment of the wound. For blind gunshot wounds, X-ray examination is necessary to determine the location of the foreign body. Prediction without timely prompt assistance is poor. Recovery is observed in rare cases of encystation.

Treatment. Possibly early laparotomy is mandatory, including in doubtful cases. Before the operation, measures are taken against shock. The operation is performed under local anesthesia or general anesthesia. The incision is made along the midline. The length of the incision should be sufficient for free inspection of the intestine. A.V. Melnikov recommends an oblique transverse incision, I.P. Vinogradov - a transverse one. Most surgeons use a midline incision. The wound canal is excised. The wound hole in the small intestine is sutured. In case of major damage, the damaged section of the intestine is resected. A two-tier suture is placed on the damaged colon. Penicillin is injected into the abdominal cavity. In case of significant damage to the colon, the damaged section of the intestine is resected, and in the wounded who are in serious condition, after cleaning the abdominal cavity, it is taken out and fixed to the abdominal wall. For extraperitoneal wounds of the large intestines, the wounds are limited to incision and tamponade. The outcome of the operation is significantly improved by additional suspended enterostomy (Fig. 164), which continuously frees the intestines from contents. This weakens intestinal paresis and intoxication. In the vast majority of cases, the surgical wound is sutured tightly.

The effectiveness of the operation depends on the proximity of the moment of operation to the moment of injury. In late cases, postoperative mortality is high.

The largest number of traumatic intestinal injuries occurs during wartime - these are mainly gunshot wounds and closed injuries due to exposure to a blast wave. During the Great Patriotic War, injuries to the colon accounted for 41.5% of all injuries to hollow organs. Of all closed injuries to the abdominal organs, 36% were closed intestinal injuries; Moreover, in 80% of cases the small intestine was damaged, and in 20% - the large intestine.

In peacetime, intestinal injuries are much less common.

Attempts have been made to classify traumatic intestinal injuries. However, these classifications have not found application due to their complexity. The most acceptable, in our opinion, for practical work is the classification proposed by A. M. Aminev (1965), which is based on the etiological principle and anatomical localization of damage to the rectum and colon. The disadvantages of this classification include the lack of indications of damage to the small intestine.

Intestinal injuries due to closed abdominal trauma in peacetime are observed in transport accidents, falls from a height, and strong compression, for example, between the buffers of cars. The degree of damage to the intestine can be different: bruise of the intestinal wall, multiple and single ruptures up to a complete transverse rupture of the intestine.

In cases where the acting force is applied non-perpendicular to the abdomen (oblique direction): the intestine may be torn off from the mesentery at the sites of fixation (proximal jejunum and distal ileum).

Due to the fact that with a closed abdominal injury, the injuries, as a rule, are combined, significant difficulties arise in diagnosis. Clinical signs of intestinal rupture include acute abdominal pain at the time of injury, rapid pulse, pain and tension in the abdominal wall muscles upon palpation of the abdomen. Upon percussion, attention is drawn to a decrease in the size of hepatic dullness due to the accumulation of gas in the subphrenic space. Obvious signs of peritonitis appear some time after the injury.

Open intestinal injuries occur due to penetration of abdominal wounds (gunshot, knife, or injury with any sharp object).

The clinical picture of acute injuries is dominated by abdominal pain of varying intensity, vomiting, increased heart rate (over 100 per minute), tension in the abdominal muscles, and severe pain on palpation. Percussion of the abdomen reveals dullness in the iliac regions as a result of fluid accumulation (outflowing blood, intestinal contents or inflammatory effusion). There is stool retention. Gases do not pass away. The addition of intestinal paresis is indicated by bloating and the absence of peristalsis on auscultation.

A significant place in the diagnosis of open and closed intestinal injuries is given to x-ray examination of the abdominal cavity, which makes it possible to detect the appearance of free gas, accumulation of fluid in the lateral parts of the abdomen, and paralytic intestinal obstruction.

Treatment of intestinal injuries is surgical. The method of surgical intervention is chosen depending on the nature of the damage.

In addition to the intestinal injuries described above, there are injuries classified by A. M. Aminev (1965) and B. L. Kandelis (1980) as household injuries (intestinal damage during medical procedures, pelvic bone fractures, operations on other organs, intestinal damage from foreign bodies, intestinal burns, etc.).

A. M. Aminev divides intestinal damage during medical procedures into 3 groups:

1. minor injuries (excoriation, cracks, tears in the transitional fold of the anal ring and mucous membrane). These types of injuries do not require treatment; they heal quickly;
2. moderate injuries (extraperitoneal dissections of the rectum, intestinal injuries without violating the integrity of the peritoneum);
3. severe injuries with disruption of the integrity of the peritoneum or surrounding organs, complicated by infection of the abdominal cavity or cellular spaces.

Mechanical damage to the rectum can be observed during rectal thermometry, speculum examination, cleansing and therapeutic enemas. During a sigmoidoscopy examination, we often saw superficial traumatic damage to the intestinal wall caused by an enema tip when the procedure was carried out insufficiently qualified. As a rule, it was a triangular defect in the mucous membrane, located along the anterior wall of the rectum at a distance of 7-8 cm from the anus.

Despite the fact that rectoscopy is considered a routine examination and is widely used in clinical and outpatient practice, in some cases it can be accompanied by complications, the most severe of which is perforation of the rectum and sigmoid colon.

Several reasons can contribute to perforation: violation of the examination technique, pronounced pathological changes in the intestinal wall, restless behavior of the patient during the examination.

The clinical manifestations of the complication depend on the size of the perforation, as well as on the virulence of the intestinal microflora and the degree of bowel cleansing before the study.

When the intestinal wall is damaged during sigmoidoscopy, the patient experiences mild pain in the lower abdomen and sometimes nausea. Soon these phenomena disappear. Only after 2 hours do signs of a developed complication appear.

In the last decade, a method such as fibrocolonoscopy has widely entered clinical practice. The importance of this method for diagnosing diseases of the colon cannot be overestimated. However, there are reports of complications during colonoscopy, of which perforation and bleeding should be considered the most dangerous.

Perforation of the intestine can occur when the intestine is wounded by an endoscope, the intestine is inflated with forced air, or pathological changes in the intestinal wall (cancer, ulcerative colitis, Crohn's disease, diverticular disease).

Bleeding is observed during biopsies from vascular formations (hemangiomas), after multiple biopsies in patients with ulcerative colitis and Crohn's disease, as well as after electrocoagulation of polyps.

According to experts, any complication after colonoscopy is the result of a violation of the research technique. Practice shows that the incidence of complications decreases as the endoscopist accumulates experience and improves examination techniques.

Damage to the anal area and rectum from sharp and blunt objects is a type of injury that is quite rare. The term “falling on a stake” was used to describe such an injury in 19th-century literature. Cases of falling on a mop handle, a ski pole, or an umbrella handle are described. As a result of the injury, acute pain in the anus occurs, including painful shock, and bleeding. There is a urge to defecate, and the passage of feces and gases through the wound canal. With injuries of this type, extensive and severe injuries develop, such as rupture of the walls of the rectum and sphincter, perforation of the pelvic peritoneum, and damage to nearby organs.

Cases of damage to the rectum and sigmoid colon during gynecological and urological operations, medical abortions and obstetrics are described. Injury to the rectum leads to infection, resulting in numerous complications (cystitis, pyelitis, phlegmon, rectovaginal and other fistulas, peritonitis).

Intestinal damage from foreign bodies. As is known, foreign bodies enter the intestine through ingestion, insertion through the anus, penetration from neighboring organs and their formation in the intestinal lumen (fecal stones).

Swallowed small objects, as a rule, move unhindered through the digestive tract and are eliminated naturally. An emergency situation arises in cases where a foreign body damages the intestine or leads to the development of obstructive obstruction.

Acute foreign bodies can cause perforation of any part of the intestine with the formation of an abscess, which during examination and even during surgery can be mistaken for a malignant tumor.

Foreign bodies sometimes enter the rectum through the anus during medical procedures (most often an enema tip), rectal masturbation, and are also the result of criminal acts. Foreign bodies can also enter the intestine from neighboring organs and tissues, for example, with gunshot wounds.

Casuistry includes cases where napkins and gauze swabs left in the abdominal cavity during surgery penetrated the intestine through the resulting bedsore and came out naturally through the anus.

And finally, it should be said about foreign bodies formed in the intestinal lumen - fecal stones. It is believed that with normal bowel function, the formation of fecal stones is unlikely. Certain conditions are required for a stone to form and remain in the intestinal lumen for a long time. One of the main conditions is the difficulty of evacuation of intestinal contents, which occurs for a number of reasons (scar strictures of the intestine, impaired innervation, intestinal atony).

In the center of the fecal stone there are dense, indigestible particles. These include fruit pits, a suspension of barium sulfate, gallstones, etc. Gradually, the stones are “enveloped” in feces, saturated with salts, and acquire significant density. Certain types of long-term medications (sodium bicarbonate, bismuth nitrate, magnesium salts) can contribute to the compaction of stones. Such dense stones impregnated with salts are called true coprolites, in contrast to false ones, which do not have time to be impregnated with salts and remain softer. False coprolites can pass through the anus on their own after oil enemas or can be removed through the anus with a finger (in whole or in parts). An example of false coprolites are fecal stones formed in elderly patients suffering from intestinal atony.

To remove large true coprolites, one has to resort to operations (laparotomy, proctotomy). Unrecognized fecal stones can cause intestinal perforation or lead to intestinal obstruction.

Spontaneous ruptures of the rectum. This includes traumatic ruptures of the rectum due to increased intra-abdominal pressure. The immediate cause of such an injury is usually a sudden significant increase in intra-abdominal pressure during heavy lifting, defecation, urination, a blow to the abdomen, a cough, a fall, or during childbirth. A pathologically altered rectum is more susceptible to rupture. Therefore, most often spontaneous ruptures can be observed in people suffering from rectal prolapse, since with this pathology the intestinal wall becomes thinner and sclerotic.

Signs of intestinal rupture are sharp pain in the lower abdomen and anus at the time of rupture, and bleeding from the anus. Prolapse of loops of the small intestine through the anus is often observed.

Chemical burns of the rectum and colon. Burns of the mucous membrane of the rectum and colon occur when ammonia, concentrated sulfuric acid is mistakenly introduced into the rectum, or when certain substances are administered for medicinal purposes.

Characteristic clinical symptoms of a chemical burn of the rectum and colon include pain localized in the lower abdomen and along the colon, frequent urges, discharge of blood and bloody films from the anus. With severe lesions, vomiting, chills, and fever are observed.

According to V.I. Oskretov et al. (1977), the introduction of 50-100 ml of ammonia into the rectum in an experiment caused a burn of the rectum and distal sigmoid colon, 400 ml - a burn of the entire colon.

Treatment of patients with chemical lesions of the colon mucosa begins with rinsing the intestines with warm water (3-5 l) or a neutralizing solution (if the substance that caused the burn is known). In addition, analgesics, sedatives, and cardiovascular drugs are administered. Then oil microenemas are prescribed (fish oil, sea buckthorn oil, rosehip oil, tampons with Vishnevsky ointment). For severe burns (necrosis of the intestinal wall), treatment is surgical.

Intestinal ruptures from the effects of compressed air have been known in the literature since the beginning of the 20th century. This injury was first described by G. Stone in 1904. Most often, such damage is the result of careless handling of a hose from a compressed air cylinder. A stream of air penetrates through the anus into the intestines, ruptures it and fills the abdominal cavity. In this case, the ampulla of the rectum, protected during inflation by the walls of the pelvis, is usually not damaged. Ruptures occur in the supramullary region, which lies above the pelvic diaphragm, and in various parts of the colon.

7407 0

Intestinal damage occurs due to road traffic and household injuries, falls from height. They can be open or closed.

Closed damage

Open damage

Clinical picture

Ruptures of the small and large intestines, especially large ones, are accompanied by symptoms of shock, internal bleeding and are characterized by the clinical manifestations of diffuse peritonitis (abdominal pain, tension in the muscles of the abdominal wall, detection of gas in the abdominal cavity during RI, disappearance of hepatic dullness or the presence of free fluid - dullness of percussion sound in sloping areas of the abdomen). Small or covered ruptures may present with a pattern of indolent peritonitis. Laparoscopy provides valuable information, especially in cases of bruise and intestinal avulsion, when the clinical picture can be relatively poor.

Diagnosis of penetrating (open) abdominal wounds does not cause much difficulty. The final fact of intestinal damage is established during laparotomy. RI also provides assistance in diagnosis.

In case of intestinal damage, emergency surgical intervention, laparotomy, and a thorough examination of the abdominal organs are performed to exclude multiple injuries. Surgical intervention should ensure complete cessation of the flow of intestinal contents into the abdominal cavity. The extent of surgical intervention depends on the nature and extent of the damage.

For small ruptures, the intestinal wall is sutured. In case of complete, multiple ruptures, separation from the mesentery, or crushing of the intestine, resection is indicated. When diffuse peritonitis has developed, when there is a threat of development of NS, it is possible to remove the intestine in the form of two end stomas, especially if the distal part of the colon is damaged. When resection of the upper parts of the TC, to prevent insufficiency of the sutures, decompressive jejunostomy should be used, creating a stoma 60-70 cm below the anastomosis and passing a thin vinyl chloride tube retrogradely above it.

Foreign bodies of the small intestine

Diagnosis is based on history and clinical symptoms of intestinal obstruction or damage.

Radiopaque (mainly metallic) FBs or complications (perforation, NK) can be detected by RI.

Treatment mostly operational. FB is removed by laparotomy and enterotomy, followed by suturing the intestinal wound with a double-row suture. In case of complications, proceed in the same way as in case of damage to the TC or its obstruction.

Grigoryan R.A.