Involvement of the intestines is a common pathology in gastroenterology, treated mainly by the surgical method.
The concept and code of the disease according to the ICD-10
Under the turn of the intestines we mean one of the varieties of intestinal obstruction, in which the thin or ruptured part of the intestine is strangulated( twisted).
Sometimes the nodulation of the caecum is established, but the duodenum is never twisted due to the strong attachment of this part to the gastric wall.
The result of twisting the node is a violation of the innervation and circulation of this part of the intestine. In the site of the violation of the axial location of the intestine relative to the intestinal mesentery, tissue necrosis is rapidly developing.
Cell death can lead to perforation of the intestine and development of peritonitis and sepsis, i.e.a threat to life is created if the pathology is not urgently eliminated.
According to the international classifier of diseases, the turn of the intestines belongs to the class K and is coded by the code number 56.2.
Several decades ago, the turn of the bowels accounted for every twentieth case of all the pathologies of intestinal obstruction. The share of the disease in modern conditions is significantly reduced due to better nutrition and social conditions.
Causes of
The pathogenesis of intestinal striation is a single mechanism, regardless of the cause that caused the pathology.
The angle in the node can be 270, 360 or more degrees at a rate of 90.
The intestinal lumen with such a bend of the wall of the hollow organ does not represent an opportunity for successful peristaltic activity, therefore, in the absence of medical intervention, intestinal toxins are accessible to the abdominal cavity, provoking in itacute inflammatory process.
The provoking factors for bowel inversion are:
- excessive feeding leads to a change in the angle of the intestinal loops, which can change dramatically with increased peristaltic intestinal activity. So can be formed as one intestinal node, and several;
- frequent intestinal constipation in the elderly can cause a change in the angle of the sigmoid colon;
- intoxication due to poor food intake causes acceleration of peristaltic movements and impaired intestinal activity, accompanied by vomiting or diarrhea, increase the risk of twisting with bowel loops;
- emergent intestinal rotations in newborns and infants are due to an incorrect location of the mesentery root relative to the intestinal wall. When laying the intestine, the root of the mesentery is perpendicular to the wall. With further growth, the angle of disposition changes from direct to acute or blunt. The deflection of the mesentery fibers from the normal degree and the change in their length cause a risk of twisting of the intestine, the length of the fibers being directly dependent on the probability of strangulation;
- development of inflammatory processes in the walls of the sigmoid colon( mesosigmoiditis) leads to a hyperplasia of the connective tissue, during which the mesentery grows and the curvature of the sigmoid colon grows. When the intestinal lumen overflows with the forming caloric masses, the probability of intestinal striation increases;
- after repeated malnutrition or hunger, there is a minimal clearance between the walls of the intestine( "the bowels are falling down").If in this state to take a large amount of food, the unfolding of the walls can occur on an unpredictable trajectory, including with a subsequent reversal of one site relative to the other;
- food, rich in pectins and vegetable fiber, has a pronounced stimulating effect on peristalsis, but the excessive prevalence of such food in the diet for a long time creates a risk for curvature of the intestines in the presence of other provoking factors;
- Twisting of intestinal loops occurs sometimes with increased tension of abdominal muscles or some physical trauma;
- postoperative cicatricial phenomena and adhesions are the causes of further progress in the increase of connective tissue, maximally approximating intestinal loops to each other and further intestinal striation.
Symptoms of gut flare
The thin and blind
The beginning of the pathology is the angle between the loops of the intestine, at least slightly exceeding the extended angle( 180 degrees) at the rate of 90.
The photo shows the x-ray with blindness of the caecum
. Due to the topographical similarity of the localization of the blind and small intestine,the curvature of the loops in both parts does not differ and is expressed by the following manifestations:
- at the time of the intestinal turn-off, the blood cells cessation of blood cells and the super-threshold stimulation of nociceptorspain receptors), coupled with baroreceptors, which respond to compression. The patient begins to feel a sudden piercing-cutting pain from that part of the abdomen, where there was a twisting of the intestinal loop;
- signs of poisoning begin to accompany the appearance of the patient and the results of the investigation immediately after the start of the entrapment of the intestinal wall: palpitation, paleness of the skin, absence of saliva in the oral cavity, pain in the muscles, a temperature maximum( over 39 degrees), sweat on the forehead. The intensity of symptoms in the course of the development of the disease begins to increase as the pathology progresses;
- in the behavior of the patient observed hyperexcitability, panic, screams. Often the patient is forced to take a position with his legs pressed to the abdomen, but the intensity of the symptoms in this position does not decrease;
- the general condition of the patient deteriorates noticeably over time: frequent fainting, insufficient muscle tone, loss of a large amount of water due to lack of it in its pure form and with food into the body and loss of its part through vomiting, dizziness;
- the patient complains of the rumbling in the abdomen, which is explained by the increase in peristaltic movements, the accumulation of food or the fecal masses that have not passed through the place of twisting of the intestine;
- immediately after the turn of the patient begins to experience attacks of vomiting, increasing with the development of the disease, but not reducing the intensity of other symptoms. Vomiting indicates an infringement in the small intestine. The nature of the emetic varies with the progress of the pathology: first, food is expelled from the stomach, then bile impurities are visible in the emetic mass, the latter emetic masses contain admixtures of fecal matter;
- a non-constant sign of intestinal curvature in the thin and sigmoid region is a gaseous congestion in the intestine, manifested morphologically by the asymmetry of the abdomen and indicating the localization of stools above the strangulation site;
- immediately after the beginning of strangulation in the lower intestine continues to function peristalsis, so gases and feces can stand out a few hours after the onset of the pathology. With prolonged course of the disease, gas and stool retention begins, which indicates the urgency of the operation on the intestine.
Sigmoid
Specific signs of intestinal swelling in the sigmoid region are:
- the displacement of the sigmoid region to the right side of the ventral side, which is expressed by the bulging of this part of the abdomen and the general asymmetry of the trunk;
- infringement of blood supply of the intestine creates an additional burden on the heart muscle, which works in an accelerated and frequent mode with interruptions( arrhythmia);
- pain develops in the lower abdomen, frequent are reflected pains in the sacrum, pelvis and coccyx. The nature of pain is constant, sometimes with sharp gains and weakenings;
- delay in the separation of feces and gases from the intestine begins almost immediately after the onset of strangulation. Shortly after the intestinal tract is pinched in this department, the peristalsis ceases;
- difficulties with breathing are explained by the localization of feces and gases in the region of the sigmoid colon, which displaces the diaphragm from the direct state into a constant domed, which creates complications in the act of inspiration;
- vomiting in the patient is due to the proximity of the nerve centers of vomiting and pain in the medulla oblongata. A strong excitation of one center causes the spread to another center. For this reason, vomiting is a protective reflex of a secondary nature, starting with a pain reflex.
Pathology in children
Several causes of gut flare are common for older children and adults, but the development of pathology in infants has several specific causes: mesentery pathology that developed in the prenatal period;early artificial feeding, abnormalities of the thick intestine during the period of embryogenesis( Hirschsprung's disease and megacolon), adhesions and a pathologically dilated mesentery.
How to save your child when turning a bowel:
Diagnosis
Usually, by palpating and collecting an anamnesis of the data, the key of which is the localization and character of the pain, the diagnosis is determined with the subsequent urgent treatment.
If time permits to diagnose the disease with more certainty, additional diagnostic methods are performed:
- review radiography;
- radiography using barite water;
- multispring spiral computed tomography;
- laboratory analysis of the determination of potassium, sodium and chlorine ions, ROE, plasma albumins, bicarbonates and phosphates;
- ultrasound examination of the abdominal cavity;
- diagnostic laparoscopy.
Colonoscopy is not recommended if intestinal strangulation is suspected.
How to treat the disease?
Operation
When the intestine is turned, the operation is performed without preliminary therapeutic procedures. The exception is the initial stage of sigmoid colon swelling, when a specialist will try to spin a loop with siphon enemas. With an unfavorable outcome of therapy with surgery, try not to delay the time.
When the abdominal opening is opened, the surgeon determines the further actions. With tissue necrosis, a partial resection of the necrotic area is carried out.
In the absence of necrotic phenomena there is an unwinding of the confused department. When a peritonitis is detected, the abdominal cavity is drained.
Traditional medicine
It makes sense to use traditional medicine when turning a gut for prophylactic purposes or in the( after) rehabilitation period. To this end, use a decoction of plum fruit, an infusion of sedge leaves, a decoction of buckthorn bark, an infusion of root beets from the dining room.
Complications of
When the operative effect is slowed down, a peritoneum and sepsis can occur in case of intestinal flare, which can be fatal.
Prognosis and prophylaxis
Involvement of the bowels, taking into account the accompanying clinical signs and the general state of the body, threaten the death of every third patient with late admission to the clinic( 3 days after the beginning of strangulation).
In surgeries after vomiting, the survival rate is 70%.