Covered perforation of the sigmoid colon: how to determine the symptoms. Perforation of the small intestine

Colon perforation is observed mainly in the cecum (about 13%).

Perforation occurs more often in men; it is based on deep penetration of the necrotic process into the intestinal wall. Usually the perforated hole is visible to the naked eye, but there are also microperforations. Simultaneous perforation may occur in several places.

Symptoms of colon perforation

Perforation of the colon may not give a typical picture acute illness, as it is masked by other manifestations of intoxication. The clinical picture is affected by the number and size of perforations. However, their main feature is the weak severity of subjective symptoms, since perforation seems to be layered against the background of severe infectious toxicosis, in which all reactions are reduced. In delirious patients, identifying signs of perforation is even more difficult.

The diagnosis of perforation is often not difficult. If perforation is accompanied by bleeding, then it is almost impossible to recognize it due to the phenomena of collapse. If perforation is suspected, an X-ray examination should be performed to determine the presence of gases in the free space. abdominal cavity. Perforation should be distinguished from sweating peritonitis, which is not accompanied by perforation. In this complication, liver dullness is preserved.

Treatment of colon perforation

The prognosis is unfavorable, since the disease has a mortality rate of over 50%. Children have a slightly better prognosis. The earlier it is produced, the better prognosis. If perforation is suspected, it is indicated under anesthesia.

During laparotomy, the intestinal wall near the perforation is thickened and swollen. Regional lymph nodes increased.

After isolating the free abdominal cavity with napkins, the perforation hole and ulcers prone to perforation are sutured. Only occasionally when good condition patients with multiple perforations or gangrenous-necrotic typhlitis, bowel resection can be performed. The abdominal cavity is sutured tightly.

Another surgical option for colon perforation is colostomy.

The affected intestine is sutured to the anterior abdominal wall as a forced procedure. Resumption of signs of peritonitis, which replaced postoperative subsidence, is a sign of repeated perforation, which requires relaparotomy. We should not forget that perforation can be combined with other sources of infection - cholecystitis. Postoperative care must be carried out .

The article was prepared and edited by: surgeon

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Intestinal perforation is the formation of a through hole in the wall of an organ through which its contents enter the abdominal cavity. In medicine, the pathology is often referred to as perforation of the colon and small intestine(depending on its location).

This is very dangerous condition, since feces, mucus and other microorganisms contained in the intestinal cavity can provoke the rapid development inflammatory process in the tissues of the peritoneum. Colon perforation is a medical emergency and without it, the risk of death increases. .

Causes of the disease

Intestinal rupture can occur in people of absolutely any gender and age, including newborns. The main causes of perforation of the mucous walls of the organ are as follows:

• – a chronic inflammatory bowel disease that develops against the background of severe infection. With it, pouch-like protrusions (hernias) form in the walls of the large intestine. Over time, they lead to a breakthrough in the organ wall;
• colorectal cancer - intestinal rupture occurs due to tumor disintegration;
• acute intestinal obstruction due to oncological or non-oncological (, ulcerative colitis) diseases;
• toxic megacolon - hypertrophy (a sharp increase in organ size due to excessive and rapid proliferation of cells) of the entire intestine or its individual part. The pathology is characterized by blockage of the intestinal lumen and increased pressure inside it;
• injuries - punctures, cuts, lacerations abdomen and hidden damaged areas of the peritoneum due to strong blunt impacts;
• , are extremely rare causes of perforation and rupture of the intestine, the wall of which is damaged by the fiber optic tube during examination. In this case, medical assistance is provided immediately.

Another factor influencing the possibility of perforation of the small or large intestine is the patient's use of immunosuppressants and individual species hormonal drugs.

Perforation of the colon in newborns is quite common. It occurs due to intrauterine development disorders:

• hypoxia – oxygen starvation fetus in the mother's womb. Occurs due to the development of multiple pathological processes (usually inflammatory in nature) in the placenta, the body of the mother or the unborn child;
• delay in the development of certain systems.

Very in rare cases Perforation of the large intestine is caused by surgery and feeding the infant enterally (through a tube in the stomach).

Symptoms and clinical manifestations

All signs of emerging pathology belong to the group clinical symptoms acute abdomen. They indicate fast and dangerous changes occurring in the abdominal cavity, which requires emergency surgical care. The patient has the following symptoms:

• spicy and intense pain in the abdominal area, worsening with movement, coughing and deep breathing. Painful sensations become a little quieter when the patient takes a position lying on his side or on his back with his knees bent;
• increased body temperature, in some cases chills are observed, febrile seizures at a temperature of 38-40 0 C;
• the skin quickly turns pale and acquires a bluish color;
• the general weakness of the patient is pronounced;
• after severe nausea vomiting begins;
• the amount of urine becomes less;
• tachycardia occurs (rapid heart rate of 90 beats per minute);
• breathing is disturbed: it becomes rapid, a little hoarse;
• when pressing on the abdomen, the pain intensifies, especially in the area where the perforation site is localized;
• Patients with colonic perforation experience hepatic dullness. Upon palpation (palpation), the dull sound disappears, which indicates the presence of gas or liquid in the abdominal cavity.

Features of the development of the clinical picture

A few hours after the formation of perforation of the colon, the severity of pain decreases because the nerve endings of the peritoneum adapt to the changes that have occurred. But the relief is temporary and dangerous. The remaining symptoms remain the same or slowly progress, and the patient’s condition worsens. At the next stage, the risk of developing intestinal peritonitis increases. In this condition, the patient begins to feel pain again. But it is no longer localized in one place, but covers all parts of the abdomen.

In rare cases, when the intestinal walls are perforated, their contents do not enter the peritoneum, but into a neighboring organ, for example, bladder. In this case, the release of gases and intestinal contents occurs from the urethra. Such clinical picture observed with lesions of intestinal loops by numerous or malignant tumors.

What is the danger?

Characteristic symptoms and the degree of their severity depend on the location of the through hole, its size, and the presence or absence of intestinal obstruction. Colon perforation is more pronounced and severe symptoms due to the rapid spread of its contents inside the peritoneum. This provokes the rapid development of peritonitis with severe intoxication of the entire body as a whole.

In the absence of help, acute illness develops liver failure, in severe cases, hepatic coma, followed by death. According to statistics, when the patient’s signs of peritonitis worsen, most patients die even with qualified surgical operations and timely resuscitation.

Diagnostics

Intestinal rupture is confirmed by a proctologist based on:

• patient complaints;
• physiological examination: palpation of the abdomen;
• general blood tests - characteristic of intestinal perforation high level immature neutrophils in the blood circulating through the vessels outside hematopoietic organs and electrolyte disorders;
• X-ray examinations - the patient is x-rayed in a standing position. In this case, the accumulation of gas under the diaphragm is clearly visible in the photographs. If the cause of perforation is intestinal obstruction, the images obtained after the x-ray are clearly visible dark spots shaped like inverted bowls;
• diagnostic peritoneal lavage - performed in cases where the above manipulations do not help establish an accurate diagnosis. The specialist takes a puncture of the liquid, which is examined for the content of blood, feces, bacteria and leukocytes.

Features of treatment

In case of perforation of the large intestine (with the exception of perforation into another organ), the patient is advised to emergency surgery. Tactics surgical intervention determined based on diagnostic results, taking into account the cause and location of the through hole in the intestine.

The surgeon makes an incision in the anterior wall of the abdominal cavity. If there is a small hole in diameter, it is sutured. In other cases, and if there is peritonitis in the peritoneum, part of the damaged intestine is removed and a colostomy is applied (a part of the colon is removed to the anterior wall of the abdomen temporarily or permanently). The abdominal cavity is washed with an infusion solution, which is then completely pumped out. Next, drainage is installed to quickly remove dead tissue and fast healing wound

During postoperative observation, the patient's pulse, blood pressure and hourly diuresis (the volume of urine produced during this time) are monitored every hour. IN mandatory the patient is given intravenous antibiotics and electrolyte solutions to destroy pathogenic bacteria and restore the processes of consumption, absorption and distribution between other organs and systems of water and salts.

Intestinal perforation

Intestinal perforation

Survival prognosis

Perforation is damage to the colon, the consequences of which are extremely unfavorable. According to statistics, in 60% of patients, intestinal perforation is complicated by peritonitis, which leads to fatal outcome.

The most important factor determining the outcome of the pathology is the time elapsed from the appearance of the first symptoms to the moment of surgery. The shorter the time period, the higher the chances of successful outcome. Other aggravating circumstances include: the age of the patient (in people of the older age group the mortality rate is higher) and the presence of severe diseases of the internal organs.

Human body - complex system, disruption of the functioning of one of the organs of which is detrimental to each of them. Intestinal perforation - dangerous phenomenon, which can lead to death. Knowing the symptoms of the pathology, sad consequences the disease can be avoided. In this case, you cannot do without the help of a surgeon.

Intestinal perforation - dangerous pathology, which is accompanied by deformation of the organ.

What is intestinal perforation called?

This pathology is extremely dangerous. It develops as a result of a violation of the integrity of the mucous membrane and the intestinal wall itself. This condition is also called intestinal perforation. In other words, a through hole appears in its wall. Through it from the intestines to abdominal area feces and intestinal juice enter. This provokes peritonitis. If the situation is not dealt with in time, the patient may die.

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Types of disease

Depending on the location of the perforation, perforation of the large and small intestines is distinguished. Each of these cases has its own reasons. Perforation of the colon is considered the most dangerous. In any case, the problem can only be solved by surgery. Pathology occurs even among newborns. If you notice its symptoms, call a doctor immediately.

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Causes of perforation

Intestinal perforation can be caused by injury, obstruction, or infection.

According to statistics, the main causes of small intestinal perforation are:

1. Injuries to the abdominal area as a result of blows with blunt objects (sticks), falls.
2. Cavity damage. They occur if a person was hit with a knife, a sharp stick, if he ran into or fell on reinforcement, etc.
3. Presence in the intestines sharp object. As a result of swallowing bone fragments, toothpicks, etc., the intestines are damaged from the inside.
4. Obstruction. Due to excessive stretching of the intestinal wall, it ruptures.
5. Infection. The occurrence of pathology is facilitated by decreased immunity, the presence of tuberculosis, and typhoid fever.

The causes of perforation of the colon are:

• diverticulitis (inflammation of pouch-like protrusions);
• cancer;
• colitis;
• volvulus;
• infection;
• foreign body;
• AIDS;
• injuries received during diagnosis;
• organ and tissue transplantation.

Perforation can be found in newborns. Boys suffer from this disease 2 times more often than girls. Certain processes contribute to the occurrence of pathology:

1. insufficient oxygen content in internal organs for a long time;
2. violation of the development of the organ system;
3. congenital intestinal obstruction or other gastrointestinal pathology;
4. enteral feeding of the child;
5. surgical intervention.

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Main symptoms

If intestinal contents enter the bladder, feces will appear in the urine. The patient finds it difficult to breathe due to severe abdominal pain. In this state, one forced position is possible - lying down, but not on a soft bed. Depending on the location of the rupture, the symptoms vary somewhat, but the general signs of pathology boil down to the following phenomena:

Intestinal perforation provokes nausea, vomiting, abdominal pain, diarrhea, and fluctuations in body temperature.

• intoxication;
• nausea, vomiting;
• abdominal wall tension;
• severe abdominal pain;
• pain in the left abdomen, radiating to the shoulder;
• increased body temperature;
• blood in urine and stool;
• diarrhea;
• lack of appetite;
• absence of sounds characteristic of bowel movements;
• weak heartbeat;
• peritonitis.

Symptoms of intestinal perforation in newborns vary significantly. Probability of death in in this case is especially high, so you need to urgently go to the hospital if you have such signs as:

• cold, dry skin in a child;
• bile in vomit;
• gray skin color.

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Diagnostics

The presence of perforation is diagnosed by palpation. The perforation is in the area that, when touched, the patient experiences the greatest pain. In addition to palpation, general tests, computed tomography and x-ray - this is how the presence of air in the abdominal cavity is determined. If the patient has recently undergone a colonoscopy procedure, you need to tell the doctor about this, as this may be the cause of the pathology. If the rupture occurred during examination, diagnostics are not needed.

Sometimes to determine the reason severe pain in the abdomen is difficult, especially in people taking chemotherapy and having undergone organ transplant surgery. In these cases, pain is considered normal and diagnosis is impossible without a computer scan. After diagnosing the perforation, preparation for surgery begins. If the patient is in agony, no preparation is carried out.

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Treatment of intestinal perforation

The pathology can only be eliminated through surgery. You cannot hesitate with such a diagnosis. If the patient has signs of perforation, he is immediately hospitalized and undergoes laparoscopy. The purpose of the operation is to sew up the hole in the intestinal wall. At the same time, existing ones are treated dangerous symptoms(heart dysfunction, etc.). If bowel contents have entered the bladder or vagina, a routine examination is necessary.

Another type of treatment used for perforation is colostomy. During this operation, the colon is removed through abdominal wall. An artificial opening is made on the patient's abdomen, which serves as a substitute for the anus. The person remains in this position certain time, until his condition allows the intestines to be stitched, but sometimes the colostomy becomes permanent. It is used in the presence of several intestinal ruptures and in case of gangrene development.

Sometimes surgery is replaced by therapy using the Taylor method. The procedure is controlled by x-rays. A probe is inserted into the perforation area. Every quarter of an hour, the contents of the intestine are removed with a syringe at the site of perforation. In parallel, the patient takes antibiotics to treat peritonitis. Scarring of the intestinal wall is controlled x-ray examination. Often such therapy ends in failure. It is impossible to talk about this type of fight against the problem as an alternative to surgery.

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Rehabilitation

After the operation, patient care is carried out according to the rules applied for peritonitis:

1. The patient should not be fed for several days after the operation;
2. Strict bed rest is observed;
3. The contents of the stomach are regularly removed through a tube.
4. the bed is set to the Fowler position (half-lying/half-sitting position);
5. carried out necessary care for postoperative wound, catheter;
6. Antibiotics, painkillers, and anti-inflammatory drugs are prescribed.

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Complications and consequences

Intestinal perforation is a dangerous pathology. If there are signs of it, you should urgently call a doctor. This problem cannot be resolved on its own. 3-5 hours after the perforation appears, gangrene begins to develop - tissues and entire organs die. Peritonitis occurs, the temperature rises, and general intoxication of the body is observed. The person is in severe pain. 50% of perforation cases result in death from peritonitis. The mortality rate among children with this diagnosis is even higher. There is no need to delay seeking medical help and stay at home, dulling the pain with pills. In this case, timing is everything. Timely qualified assistance will save a person’s life.

Causes of perforation

In newborns, the development of the disease is often associated with congenital pathologies or abnormal development during fetal development.

Perforation can be caused by:

• hypoxia,
• delay in the development of certain systems,
• by enteral feeding,
• obstruction,
• surgical intervention.

Punctures in newborns are extremely rare. According to statistics, boys are twice as likely to develop this pathology as girls.

This disease is characterized by inflammation of diverticula against the background of stagnation of intestinal contents. Most often, perforation is associated with the formation of abscesses.

Sometimes the problem is a consequence of colorectal cancer. Violation of the integrity of the organ occurs due to:

• tumor disintegration,
• obstruction of the lumen,
• fecal pressure,
• blood supply disorders.

Traumatic causes include blunt trauma in the abdomen, abdominal injury, ingestion of a sharp object.

In all cases, symptoms of an acute abdomen are characteristic. Patients begin to complain of pain of strong intensity, spare it when breathing, try for a long time remain motionless.

Body temperature first stays at 37-37.5 degrees, then rises to higher levels.

When perforation of the large and small intestines occurs:

• intoxication of the body,
• bleeding,
• inability to urinate,
• lack of intestinal motility, nausea and vomiting.

If perforation occurs in the rectum, then in addition to pain, you can find blood in the stool and a false urge to defecate. Due to the uneven increase anus Involuntary release of gas or feces may begin. In some cases, purulent discharge is detected.

If a problem occurs in the area sigmoid colon pain appears in the left iliac region. The patient's condition deteriorates sharply; the fever can be hectic in nature with large daily fluctuations. Bleeding may occur.

Sometimes it is the only symptom violation of the integrity of blood vessels. Blood does not mix with feces and does not change its color. Signs of anemia appear.

Perforation of the duodenum occurs in three periods of pain formation. First, severe “dagger” pain occurs when the contents of the organ enter the abdominal cavity. It is localized in the upper sections, then spreads along the right or left edge of the abdomen.

There is a strong tension in the anterior abdominal wall. The face becomes pale with an ashen-cyanotic tint. Perspiration appears on the forehead, hands and feet become cold. About 20% of those diagnosed experience vomiting once.

During colonoscopy

In rare cases, intestinal perforation occurs during colonoscopy. During the procedure through anus a probe with a camera is inserted. If it is administered incorrectly, the intestinal wall is damaged. In such a situation, symptoms appear immediately.

If symptoms appear 1-2 days after the procedure, then most often this is due to the formation of perforation at the site of polypectomy. The latter during this time transforms into burn necrosis of the wall. The disruption of integrity may be small or appear first between the layers of the mesentery.

The incidence of perforation during colonoscopy is 1 in 500 cases and depends on the purpose of the intervention. There are three possible mechanisms responsible for the occurrence of perforation:

1. Straight line, which appears as a result of working with a colonoscope or forceps.
2. Barotrauma formed by large injection of air.
3. Perforation resulting from medical procedures.

Diagnostics

The presence of intestinal perforation is diagnosed by a proctologist. Based on the results of collecting an anamnesis, the issue of conducting a physical examination, instrumental and laboratory research. Typically, diagnostics allow an accurate diagnosis.

Done x-ray, which shows the presence of free gas in the abdominal cavity under the diaphragm.

If the problem is caused intestinal obstruction, the images reveal shadows in the form of inverted bowls with a horizontal liquid level.

Clinical blood and urine tests are not always informative. There is a shift of leukocytes to the left. 4-5 hours after the formation of perforation and the establishment of the peritonitis phase, the diagnosis is established as accurately as possible.

Treatment

Conservative treatment with antibiotics is usually prescribed only if perforation occurs during therapeutic colonoscopy. In all other cases, surgery is required.

Conservative treatment requires constant administration of enemas, use of antibiotics, and sanitization of the abdominal cavity. In order not to overload the intestines, a diet is prescribed.

The damaged part is treated, then sutures are applied. At the same time, a special gauze is introduced, which is coated with an antiseptic. It sinks into the small intestine.

If the case is severe, then first the perforation site is tamponed, disinfected, and only then sutured.

The latter is carried out according to special technique so as not to disrupt the connection between organs. Sometimes surgical method involves laparoscopy. At the same time, it is carried out drug treatment concomitant diseases, for example, heart failure.

Survival prognosis

Intestinal perforation is dangerous disease. With the rapid spread of organ contents inside the peritoneum, peritonitis quickly develops and severe intoxication of the entire body occurs.

The main factor determining the outcome of the problem is the time from the onset of the first symptoms to surgical intervention. The shorter this period, the greater the chances of a favorable outcome.

Aggravating circumstances include the patient's age and the presence of other serious illnesses internal organs.

Video story of a small patient with intestinal perforation:

Intestinal perforation: what is it?

The word “perforation” means the formation of a hole that crosses a plane through and through. In the case of the intestine, this plane will be its wall itself, perforated as a result of the development of any pathological processes in the body.

Intestinal perforation is a dangerous condition. The mucous membrane is usually damaged by the following factors:

• external influence on the body;
• internal processes of the body.

The desired condition in specialized medical publications is described by another term: “awakening.” The “hole” can be located in any segment of the organ:

• large intestine;
• thin.

The location of the perforation cannot be predicted with certainty; the pathology can be localized in any part of the intestine, depending on a combination of many different reasons.

Video - Intestinal perforation: what is it, symptoms

At-risk groups

It is impossible to single out a specific group of people most susceptible to intestinal perforation. Since this disease itself is most often a consequence of other pathological processes developing in the body, it can manifest itself in representatives of any age group:

• children;
• youth;
• adults;
• elderly.

In addition, the severity of the disease is also not determined by age characteristics. The presence of other, no less serious diseases influences the patient’s condition during intestinal perforation.

Even parents of newly born babies should be careful, since intestinal perforation may occur while still in the womb. After discharge from maternity hospital Mothers should not only increase their level of vigilance, but also remember to show their child to the doctor if any negative symptoms occur.

Consequences of perforation of the intestinal walls

The danger of a hole in the intestinal wall is a very serious question. Unfortunately, most citizens cannot answer this question because they do not understand medicine. This entails dangerous delay, which, as we all know, is like death.

When the integrity of the mucous walls of the intestine is disrupted, part of the contents passing through the organ penetrates directly into the abdominal cavity, creating favorable conditions for the development of complications of high severity.

These include:

• peritonitis is an inflammation of the peritoneum (the cavity in which the organs are located), more precisely, its serous covering, a disease that can only be cured surgically, accompanied by very serious condition patient;
• sepsis – purulent infection, in fact, blood poisoning and transition inflammatory disease on new level, a very life-threatening condition of the patient, in which death is very likely;
• other diseases that have high degree gravity.

Independent attempts to stop the disease can lead to two consequences:

• give no result;
• suppress the symptoms, as a result of which you will lose valuable time, and medical care may ultimately not have the desired effect.

Possible causes of the formation of a perforated intestinal ulcer

Unfortunately, there can be many reasons for the formation of the desired pathology in one of the most important organs of the digestive system of our body. We list the most popular of them, including those that you might not have even thought of before.

Reason #1. The cause being sought is the most outrageous, as it describes the occurrence of a damaged area in the intestine as a result of unprofessional endoscopic examination intestinal cavity - colonoscopy.

As is known, this procedure is carried out using special tool: endoscope. With its help the following are produced:

• examination of the walls and insides of the intestines;
• taking samples from the walls for laboratory testing.

To serve medical purposes for many years, the endoscope is made of hard but flexible materials. However, careless movement by an inexperienced specialist can lead to a breakthrough in the intestinal walls, or their damage and inflammation, the progression of which will also result in the formation of a hole.

Trust the implementation of the required medical procedure Only necessary for an experienced physician. It is best for a professional to have decades of experience. Usually you can find reviews about doctors on the Internet, the more positive characteristics from patients who have received treatment from a particular doctor, the better. Often reviews are located directly on the official website of the medical institution.

Please note next fact: usually when the intestines are perforated during a colonoscopy, symptoms appear immediately upon completion of the procedure, therefore, under no circumstances remain silent and tell the doctor about your condition, relief of the consequences at this stage will occur without complications.

Often the required procedure is carried out to remove a polyp - a growth from the intestinal walls localized in its thick segment. Since there are different techniques for removing the desired formation, perforation may be associated with:

• mechanical damage;
• burn.

As a result of improper operation, necrotic processes begin at the site of damage, the tissue dies and disintegrates, and a hole appears.

It will take at least three to five days for the intestinal wall to perforate due to damage after removal of the polyp. Then the typical clinical picture will begin to appear.

Reason #2. Congenital intestinal perforation– rather not a cause, but a phenomenon. Of course, it does not mean that a person will be born with a leaky intestine, and his quiet life after, because it’s simply impossible. A baby is born with a hole in the walls of the intestine, and at first this may not be noticed, however, after discharge, symptoms begin to appear.

The prerequisites for babies being born with a damaged organ are as follows:

• he has a congenital pathology;
• abnormal development of the fetus occurred in the womb (due to genetic reasons, mother’s illness, her poor lifestyle, and the like).

Here it is important to realize in time to see a doctor, without attributing the strange behavior of the newborn to bloating and other troubles. Of course, you should remain adequate and stop being afraid of every sob of the baby, but in no case should you turn a blind eye to the obvious symptoms.

Reason #3. One more common reason rupture of the intestinal mucosa: external influence, received in the form:

• injuries resulting from a fall;
• damage sustained in an accident;
• rupture as a result of injury from a bladed weapon or firearm;
• swallowing any indigestible object, the sharp edges of which have torn the intestinal walls.

Of course, when leaving home, each of us risks having an accident in our own car, tripping and falling on a metal pin protruding from the ground, or being injured as a result of an attack by bandits. Any physical impact that occurs in the abdominal area will quite possibly lead to a breakthrough of the intestinal walls. In this case, it is important to react quickly, call an ambulance, or ask passers-by to take you to the hospital.

Reason #4. Pathological processes already present in our body, can also cause gradual or sudden deformation of the walls, which ultimately disintegrate and form a through hole. These include:

• inflammatory processes of various etiologies (for example, colitis or enteritis);
• saccular protrusion of the mucous membrane of the large or small intestine;
• cancer processes in the intestines;
• acquired immunodeficiency syndrome.

Symptoms

It must be said that the symptoms of intestinal perforation may vary depending on the location of the breakthrough of the intestinal mucous walls. However, there are still manifestations common to all, since:

• increased level of intoxication;
• high body temperature;
• nausea and vomiting;
• tension in the abdominal cavity, which is felt by simply placing your palm on the front wall of the abdomen;
• sharp pain on the left side in the hypochondrium;
• shoulder pain (radiating from the intestines);
• when listening to the intestines, standard sounds for the intestine are not heard;
• During defecation, blood may be found in the stool;
• there is also blood mixed in the urine;
• appetite disappears and after a while anorexia begins to appear;
• heart beats are rare and weak;
• possible dyspeptic disorders in the form of diarrhea;
• the peritoneum becomes inflamed and causes severe pain.

When the intestines rupture, it is also possible for feces to penetrate into the bladder, as a result, when urinating, feces will also come out through the urinary duct. In addition, the patient will be in so much pain that he will be afraid to breathe. The only way to slow down a little painful sensations– lie down on a hard surface.

Infants with intestinal perforation exhibit their own symptoms. These include:

• low skin temperature, it becomes cold to the touch;
• dry epithelium;
• pallor skin and mucous, gray and white shades;
• Vomiting may occur, and bile will be present in it.

Unfortunately, the endurance of children, compared to the stronger body of an adult, is very small. Even a small lapse of time is fraught with death or long-term, heavy treatment and constant operations, which can also end in death, because children do not have enough resources to recover independently after such a serious intervention.

How to diagnose and treat intestinal perforation

It is absolutely impossible to independently diagnose, let alone cure, intestinal perforation. If symptoms appear, you should immediately go to the doctor.

The specialist, in turn, will palpate the abdomen, identifying changes in sensations that have occurred, and then prescribe diagnostic measures:

• in laboratory conditions;
• instrumental.

• radiographic;
• computed tomography.

Both of these studies are considered the most informative. If after these tests the diagnosis of “perforation of the intestinal wall” is confirmed, the patient begins to undergo preparatory preoperative procedures. Surgery is the only way to eliminate the disease, treatment conservative method does not give any results.

On average preparatory stage takes from two to four hours, however, if the patient is in a state of shock, preliminary preparation you have to skip it and treat immediately.

The operation takes place in the following several stages, presented in the table.

Table 1. Surgical treatment intestinal perforation

The required operation is considered easy consequence perforation, it’s great if there were no complications and the gap was repaired early stages. However, if there is serious complications, the so-called formation of a colostomy is carried out - an opening in the abdomen into which the intestine is removed, through which feces, gas and other biological substances will be removed in the future.

Colostomy is often indicated not only for intestinal perforation, but also for other diseases of the organ in question that are complicated by various consequences.

After the operation, the sick person receives additional conservative treatment, namely:

• takes antibiotics;
• anti-inflammatory drugs;
• painkillers.

In addition, strict fasting is prescribed for several days after the intervention; nutrients are supplied to the patient through injections and droppers.

Let's sum it up

Intestinal perforation is dangerous pathological process, developing in the human body. Many reasons can lead to the formation of a hole in the intestinal walls, sometimes even medical workers cannot accurately determine the specific one.

We advise you to stick to one the most important rule: if symptoms characteristic of this disease appear, do not hesitate, but seek qualified help from a licensed medical institution.

Remember self-treatment Not only may it not give any effect, but it can also suppress the symptoms - a valuable evidence of the disease, important for its timely diagnosis. In addition, a blurred picture of the patient’s sensations can lead to the illusion that his condition does not require treatment, and when pain and other symptoms return, it will be too late.

The human body is a complex system, disruption of the functioning of one of its organs is detrimental to each of them. Intestinal perforation is a dangerous phenomenon that can lead to death. Knowing the symptoms of the pathology, the sad consequences of the disease can be avoided. In this case, you cannot do without the help of a surgeon.

Intestinal perforation is a dangerous pathology that is accompanied by deformation of the organ.

What is intestinal perforation called?

This pathology is extremely dangerous. It develops as a result of a violation of the integrity of the mucous membrane and the intestinal wall itself. This condition is also called intestinal perforation. In other words, a through hole appears in its wall. Through it, feces and intestinal juice enter the abdominal region from the intestines. This provokes peritonitis. If the situation is not dealt with in time, the patient may die.

Types of disease

Depending on the location of the perforation, perforation of the large and small intestines is distinguished. Each of these cases has its own reasons. Perforation of the colon is considered the most dangerous. In any case, the problem can only be solved by surgery. Pathology occurs even among newborns. If you notice its symptoms, call a doctor immediately.

Causes of perforation

Intestinal perforation can be caused by injury, obstruction, or infection.

According to statistics, the main causes of small intestinal perforation are:

1. Injuries to the abdominal area as a result of blows with blunt objects (sticks), falls.
2. Cavity damage. They occur if a person was hit with a knife, a sharp stick, if he ran into or fell on reinforcement, etc.
3. Presence of a sharp object in the intestine. As a result of swallowing bone fragments, toothpicks, etc., the intestines are damaged from the inside.
4. Obstruction. Due to excessive stretching of the intestinal wall, it ruptures.
5. Infection. The occurrence of pathology is facilitated by decreased immunity, the presence of tuberculosis, and typhoid fever.

The causes of perforation of the colon are:

• diverticulitis (inflammation of pouch-like protrusions);
• cancer;
• colitis;
• volvulus;
• infection;
• foreign body;
• AIDS;
• injuries received during diagnosis;
• organ and tissue transplantation.

Perforation can be found in newborns. Boys suffer from this disease 2 times more often than girls. Certain processes contribute to the occurrence of pathology:

1. insufficient oxygen content in internal organs for a long time;
2. violation of the development of the organ system;
3. or other gastrointestinal pathology;
4. enteral feeding of the child;
5. surgical intervention.

Main symptoms

If intestinal contents enter the bladder, feces will appear in the urine. The patient finds it difficult to breathe due to severe abdominal pain. In this state, one forced position is possible - lying down, but not on a soft bed. Depending on the location of the rupture, the symptoms vary somewhat, but the general signs of pathology boil down to the following phenomena:

Intestinal perforation provokes nausea, vomiting, abdominal pain, diarrhea, and fluctuations in body temperature.

• intoxication;
• nausea, vomiting;
• abdominal wall tension;
• severe abdominal pain;
• pain in the left abdomen, radiating to the shoulder;
• increased body temperature;
• blood in urine and stool;
• diarrhea;
• lack of appetite;
• absence of sounds characteristic of bowel movements;
• weak heartbeat;
• peritonitis.

Symptoms of intestinal perforation in newborns vary significantly. The likelihood of death in this case is especially high, so you need to urgently go to the hospital if you have such signs as:

• cold, dry skin in a child;
• bile in vomit;
• gray skin color.

Diagnostics

The presence of perforation is diagnosed by palpation. The perforation is located in the area where the patient experiences the greatest pain when touched. In addition to palpation, general tests, computed tomography and x-rays are performed to determine the presence of air in the abdominal cavity. If the patient has recently undergone a colonoscopy procedure, you need to tell the doctor about this, as this may be the cause of the pathology. If the rupture occurred during examination, diagnostics are not needed.

Sometimes it is difficult to determine the cause of severe abdominal pain, especially in people taking chemotherapy drugs or having undergone organ transplant surgery. In these cases, pain is considered normal and diagnosis is impossible without a computer scan. After diagnosing the perforation, preparation for surgery begins. If the patient is in agony, no preparation is carried out.

Treatment of intestinal perforation

The pathology can only be eliminated through surgery. You cannot hesitate with such a diagnosis. If the patient has signs of perforation, he is immediately hospitalized and undergoes laparoscopy. The purpose of the operation is to sew up the hole in the intestinal wall. At the same time, existing dangerous symptoms (heart dysfunction, etc.) are treated. If bowel contents have entered the bladder or vagina, a routine examination is necessary.

Another type of treatment used for perforation is colostomy. During this operation, the colon is removed through the abdominal wall. An artificial opening is made on the patient's abdomen, which serves as a substitute for the anus. A person remains in this position for a certain time until his condition allows the intestines to be sewn together, but sometimes the colostomy becomes permanent. It is used in the presence of several intestinal ruptures and in case of gangrene development.

Sometimes surgery is replaced by therapy using the Taylor method. The procedure is controlled by x-rays. A probe is inserted into the perforation area. Every quarter of an hour, the contents of the intestine are removed with a syringe at the site of perforation. In parallel, the patient takes antibiotics to treat peritonitis. Scarring of the intestinal wall is monitored by x-ray examination. Often such therapy ends in failure. It is impossible to talk about this type of fight against the problem as an alternative to surgery.

Violations gastrointestinal tract vary in nature, etiology and severity. However, most pathologies are dangerous to human health and life.

One of the dangerous diseases is intestinal perforation. This disease is characterized by depletion of the walls, which leads to severe damage to the mucous membrane. IN traditional medicine pathology is designated by the term “perforation”.

Today, the pathology is quite common, so you need to know what perforation is, the main types, causes and symptoms.

Main types of perforation

On at the moment There are two classifications of the disease: according to localization, according to the severity of the disorders. Intestinal perforation, or devirticular pathology, in ICD 10 is designated by code K57.

Based on the location of the violation, there are two types:

• perforation in the small intestine;
• colon failure.

Pathology occurs due to natural causes. However, there are cases when the disease develops against the background of surgical interventions and complex diagnostic procedures. In this situation, perforation is divided into three types, based on the degree of damage:

• lungs;
• average;
• severe injuries accompanied by rupture.

Perforation

The pathology requires emergency surgery; prolonged treatment requires high risk lethal outcome.

Please note that if the baby is at risk of perforation, it is necessary to remain under observation for some time in the conditions of the perinatal center.

Pathology of the small intestine - the main causes

The small intestine is less susceptible this kind pathologies. Based on WHO (World Health Organization) statistics, we can conclude that such a disease carries fewer dangerous complications.

However, the disease requires urgent surgical intervention. Perforation may affect the duodenum, ileum. As a rule, pathology occurs in adulthood and most often in men. The main reasons provoking the development of perforation.

• Mechanical impacts, injuries: falls, accidents, intense impacts.
• Severe intestinal obstruction. Over time, stretching occurs to critical values, after which a rupture or acute disorder integrity.
• Progressive stomach ulcer or duodenum(perforated type) without therapeutic effects, the development of an inflammatory process can be observed.
• Penetration of a foreign body into the body. In this situation, a gradual endogenous mechanical impact on the intestines.
• Various types of infectious pathologies - typhoid fever, sharp decline protective functions immune system, tuberculosis, diseases caused by viruses or bacteria.
• Presence of a tumor in the organs reproductive system: uterus, ovaries.
• Wounds penetrating into the abdominal area - puncture injuries, gunshot.

Small intestine

Important! Perforated intestines are a danger to the body, since the contents can penetrate into other areas and provoke the development of inflammation.

Why does colon perforation develop?

A disease of this kind is a pronounced deformation of the wall, most often of the cecum. There is a disturbance in the rectum. Similar pathology considered more dangerous than deformities small intestine. Deformities may affect the sigmoid colon

The most common causes of colon damage are:

• Cancers that differ in stage and location malignant neoplasms. In this case, the treatment prognosis is unfavorable.
• Diverticulum is a pronounced multiple protrusion of one of the areas of the intestine, congenital or acquired.
• Immunodeficiency virus.
• Rehabilitation period after surgery for implantation of skin, tissue or organs.
• Sigmoiditis is severe inflammation of the sigmoid process of the intestine.
• Availability in digestive system foreign objects.
• Colonoscopy or sigmoidoscopy – complex diagnostic procedures, during which the sigmoid and rectal sections of the intestine may be damaged.

Colon

It should be noted that the rectum is most important organ Gastrointestinal tract, its disorders have negative impact on general condition person.

Intestinal perforation: symptoms and clinical picture

Signs of pathology vary depending on the location where the wall is damaged. Intestinal perforation, symptoms and treatment in adults differ from manifestations and treatment in newborns, infants and children.

In number common features pathologies include:

• pronounced acute pain syndrome in the abdominal region;
• intense nausea, urge to vomit;
• stool abnormalities are observed in stool and urine blood streaks, mucus;
• reduction in heart rate;
• strong tension in the peritoneal area, easily determined by palpation of the abdomen;
• development of anorexia, loss of appetite;
• manifestation of the inflammatory process in the stomach, peritonitis;
• absence of characteristic bowel sounds.

Pain syndrome

The main symptom of perforation is the inability to breathe freely due to acute pain. As the pathology develops, fecal impurities appear in the urine.

Additional symptoms:

1. dry skin, the shade changes and approaches gray;
2. intense vomiting occurs, the vomit includes streaks of bile;
3. pronounced causeless cooling of the skin.

Suspicion of perforation as in an adult age group, and in children - a reason to seek emergency medical care. Timely treatment– this is a significant reduction in the risk of complications; in the opposite case, it is noted high percentage fatal outcome.

Necessary diagnostic tests

Self-identification or treatment of perforation is strictly prohibited. To make a diagnosis, diagnostic procedures are required.

1. Initial examination by a specialist, medical history collection.
2. Irrigoscopy is a specialized examination of the rectum.
3. X-ray or computed tomography of the abdominal organs.
4. General clinical studies: blood, stool, urine tests.

Carrying out diagnostics allows you to make an accurate diagnosis and begin treatment.

Important! Modern therapy perforation requires mandatory surgery.