Intestinal perforation is a dangerous pathology that, if left untreated, leads to death. The disease is found at any age, including in newborns. It is an end-to-end lesion in which the contents of the organ enter the abdominal cavity.
Causes of perforation
In newborns, the development of the disease is often associated with congenital pathologies or abnormal development during intrauterine development.
Perforation can be caused by:
- hypoxia,
- development delay of certain systems,
- by feeding in an uncontrolled manner,
- obstruction,
- by surgery.
Punctures in newborns are extremely rare. According to statistics, in boys the risk of developing such a pathology is two times more likely than that of girls.
For this disease, inflammation of the diverticulum is characteristic because of stagnation of intestinal contents. Most often, perforation is associated with the formation of abscesses.
Sometimes the problem is a consequence of colorectal cancer. Integrity of the organ is due to:
- tumor disintegration,
- luminal obstruction,
- fecal pressure,
- blood supply disturbance.
For traumatic reasons, a blunt trauma occurs in the abdomen, wounding the abdomen, swallowing a sharp object.
Symptoms of intestinal perforation
In all cases, the symptomatology of an acute abdomen is characteristic. Patients begin to complain of pain of strong intensity, spare it with breathing, try to remain immobile for a long time.
Body temperature first rests on the marks of 37-37.5 degrees, then rises to higher marks.
When perforating the thick and small intestine it is noted:
- body intoxication,
- bleeding,
- inability to urinate,
- absence of intestinal peristalsis, nausea and vomiting.
If the perforation has arisen in the rectum, then in addition to pain, blood in the feces can be detected, and the urge to defecate is false. In connection with an uneven increase in the anus, involuntary release of gas or feces may begin. In some cases, purulent discharge is found.
If there is a problem in the sigmoid colon area, the pain appears in the left ileal region. The patient's condition deteriorates sharply, fever can be hectic in nature with large daily fluctuations. There may be a bleeding.
Sometimes it is the only symptom of vascular disruption. Blood does not mix with feces, does not change its color. There are signs of anemia.
Perforation of the duodenum proceeds in three periods of pain formation. First, a strong "dagger" pain occurs when the contents of the organ enter the abdominal cavity. It is localized in the upper parts, then spreads to the right or left side of the abdomen.
There is a strong tension in the anterior abdominal wall. The face becomes pale with an ash-cyanotic shade. There is perspiration on the forehead, hands and feet become cold. Approximately 20% with a diagnosis there is a single vomiting.
When colonoscopy
In rare cases intestinal perforation occurs when performing a colonoscopy. During the procedure, a probe with a camera is inserted through the anus. If it is not entered correctly, the intestinal wall is damaged. In this situation, the symptomatology appears immediately.
If the symptomatology appeared 1-2 days after the procedure, then most often it is due to the formation of perforation in the place of polypectomy. The latter during this time is converted to burn wall necrosis. Violation of the integrity may be small or appear first between the leaves of the mesentery.
The perforation frequency in a colonoscopy is 1 in 500 cases and depends on the purpose of the intervention. There are three possible mechanisms responsible for the appearance of perforations:
- A straight line that appears as a result of working with a colonoscope or forceps.
- Barotrauma, formed with a large introduction of air.
- Perforation resulting from treatment procedures.
Diagnosis
The presence of perforation of the intestine is diagnosed by a proctologist. Based on the results of the history, the issue of physical examination, instrumental and laboratory research is being solved. Usually the diagnosis allows you to make an unmistakable diagnosis.
An x-ray is taken, which shows the presence of free gas in the abdominal cavity beneath the diaphragm.
If the problem is caused by an intestinal obstruction, the images show blackouts in the form of inverted bowls with a horizontal liquid level.
Clinical blood and urine tests are not always informative. Leukocytes are marked with a shift to the left.4-5 hours after the formation of perforation and the establishment of the phase of peritonitis, the diagnosis is established as accurately as possible.
Treatment of
Conservative treatment with the administration of antibiotics is usually prescribed only if the perforation occurs during the therapeutic colonoscopy. In all other cases, surgical intervention is required.
Conservative treatment requires constant administration of enema, the use of antibiotics, sanitation of the abdominal cavity. In order not to overload the intestines, a diet is prescribed.
The damaged part is processed, then joints are applied. At the same time, a special gauze is applied, which is covered with an antiseptic. It is submerged in the small intestine.
If the case is severe, then the place of perforation is tamponed, disinfected, and then sewed up.
The latter is carried out in a special way, so as not to disrupt the communication between the bodies. Sometimes the surgical method involves carrying out laparoscopy. At the same time, medical treatment of concomitant diseases, for example, heart failure, is carried out.
Survival prognosis
Intestinal perforation is a dangerous disease. With the rapid spread of the contents of the organ inside the peritoneum there is a rapid development of peritonitis and a strong intoxication of the whole organism.
The main factor determining the outcome of the problem is the time from the time of the onset of the first symptoms to surgical intervention. The shorter this period, the greater the chance of a favorable outcome.
Aggravating circumstances is the age of the patient and the presence of other serious internal diseases.
A video story of a small patient with intestinal perforation: