Large bowel obstruction
Introduction
Introduction to large bowel obstruction Large bowel obstruction (LBO) is a group of emergencies that require early identification and active intervention. The cause of the disease varies according to age, and is divided into mechanical obstruction and dynamic obstruction (pseudo-obstruction). The main causes of middle-aged and elderly patients include tumors, inflammatory lesions (diverticulitis), stenosis, fecal incarceration or torsion. Neonates are mainly caused by abnormal anal development or other anatomical abnormalities as well as meconium. basic knowledge The proportion of illness: 0.07% Susceptible people: overeating, people with intestinal dysfunction. Mode of infection: non-infectious Complications: electrolyte imbalance ischemic necrosis
Cause
Cause of colorectal obstruction
Acute pseudo-colon obstruction (Ogilvie syndrome) (15%):
Fariano believes that the disease is associated with parasympathetic dysfunction of the ankle. Matsui reported that some of the nerve conduction dysfunction caused the disease, and under the microscope, the number of ganglion cells in the intestinal wall was reduced, and the nerve cells were degenerative.
Colonic obstruction caused by postoperative pelvic adhesion (20%):
The characteristics of this disease are: more than 1 occurred in middle-aged women after pelvic surgery; 2 intermittent abdominal distension, chronic abdominal pain and constipation; 3 barium enema without special lesions; 4 fiber colonoscopy showed sigmoid colon angle, also stenosis, stop the colon The mirror enters.
Cancerous obstruction (20%):
The primary cause of colonic obstruction.
Colon torsion (20%):
The second common cause can occur in the cecum, transverse colon and sigmoid colon, but is most common in the sigmoid colon.
Colonic schistosomiasis (10%):
In China's schistosomiasis endemic area, schistosomiasis granuloma or colon cancer is still seen.
Obstruction caused by compression or invasion of extra-colonal tumors (5%):
For example, pancreatic cancer or gastric cancer invades the transverse colon and causes obstruction; it is not uncommon for female pelvic tumors, especially ovarian tumors, to cause obstruction caused by sigmoid colon.
Gallstone obstruction (2%):
It accounts for 1% to 3% of all intestinal obstruction, and the preoperative diagnosis rate is only about 15%.
Prevention
Prevention of large bowel obstruction
Overeating, intestinal dysfunction is the cause of intestinal obstruction, so the daily diet should pay attention to nutrient-rich and easy to digest, a small number of meals, do not eat more irritating food, which can reduce the occurrence of large bowel obstruction.
Complication
Colorectal obstruction complications Complications, electrolyte imbalance, ischemic necrosis
The disease can cause loss of body fluids and electrolytes as well as complications such as infection and toxemia.
Symptom
Symptoms of large intestine obstruction Common symptoms Aphid ileus obstruction Abdominal pain with nausea, vomiting, peritoneal irritation, abdominal muscle tension, bowel, stop, exhaust, fecal vomit, abdominal pain, bloating, suffocation
1. All patients have abdominal pain. The right colonic obstruction is mostly located in the right upper abdomen. The left half is mostly in the left lower abdomen. The chronic obstruction has slight abdominal pain. The acute obstruction has severe abdominal pain, but it is not as severe as intestinal torsion and intussusception.
2, nausea, vomiting appeared later, or even absent. Later, the vomit was yellow fecal-like content with a foul smell.
3, abdominal distension is less obvious intestinal obstruction, both sides of the abdomen prominent, sometimes horseshoe shape.
4, the anus stops defecation and exhaust, but most patients still have a small amount of gas in the early stage of obstruction.
5, physical examination see abdominal distension is obvious, can be horseshoe-shaped, percussion is drum sound, auscultation can smell the sound of water, X-ray film examination can be seen in the colon with obvious fluid, gas, and liquid level.
Examine
Examination of large bowel obstruction
1. X-ray examination: multiple liquid and gas planes and flatulence and intestinal fistula can be seen in the standing position.
2, blood routine: blood white blood cell count is generally above 10 × 1O9 / L, strangulated intestinal obstruction is often above 15 × 109 / L, neutrophils increased.
3, serum carbon dioxide binding force determination: when metabolic acidosis occurs, carbon dioxide binding capacity can be reduced.
4. Determination of serum electrolytes: hypokalemia, hypochloremia and hyponatremia may occur.
Diagnosis
Diagnosis and diagnosis of large bowel obstruction
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis:
Mainly should be differentiated from small bowel obstruction. Small bowel obstruction is a kind of acute abdomen in dogs. It is often caused by mechanical obstruction in the intestinal lumen of the small intestine or irreversible changes in the normal position of the small intestine, such as nesting, incision, and torsion. In addition to intestinal obstruction, small bowel obstruction is accompanied by local blood circulation disorders. Typical symptoms of small bowel obstruction are abdominal pain, vomiting, bloating, and defecation.
