fecal perforation of colon
Introduction
Introduction to colonic fecal perforation Colonic fecal perforation (SP) is a rare form of fatal acute abdomen. In 1972, Bauer reported 4 cases and reviewed 25 cases of literature. Later, there were cases reported in the literature. In 1990, Serpell statistics from 1984 to 1990. There were 64 cases in the literature and 3 cases in 1995. The incidence of colonic fecal perforation is unknown, but according to autopsy, the incidence is greater than 5%. basic knowledge The proportion of illness: 0.03%--0.08% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: peritonitis shock
Cause
Cause of colonic fecal perforation
Chronic constipation is the main pathogenic factor of fecal ulcer, and its pathogenesis may be:
1 The dry fecal mass in the colon directly compresses the intestinal mucosa, causing pressure-induced ischemic necrosis of the mucosa, thereby forming ulcers and even perforations;
2 a large amount of fecal mass is deposited in the colon to make the intestines highly expand, the intestinal pressure rises and exceeds the capillary diffusion pressure of the intestinal wall, especially the intestinal wall opposite the mesangial margin, leading to ischemia and necrosis of the intestinal wall;
3 mechanical intestinal obstruction caused by fecal block, direct perforation caused by increased intestinal pressure, especially when the intestinal wall has existing lesions, the fecal block acts to expand the intestinal lumen, when the internal pressure is higher than the intestinal wall capillary perfusion At the time of compression, especially on the edge of the mesentery, ulceration occurs first, followed by perforation.
Prevention
Colonic fecal perforation prevention
There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention.
Complication
Complication of colonic fecal perforation Complications peritonitis shock
1. Secondary peritonitis.
2. Infection with toxic shock.
Symptom
Colonic fecal perforation symptoms Common symptoms Abdominal pain Abdominal local or wide... Peritonitis persistent lower abdominal pain constipation Colonic fecal perforation One side lower abdominal painful calcification
SP occurs in the elderly, abdominal pain generally begins in the left lower abdomen, gradually involving the whole abdomen, defecation activities often cause abdominal pain suddenly increased, there are peritonitis manifestations at the time of treatment, about one-third of patients can be due to a large number of fecal mass in the intestine In the abdomen touched the mass, half of the patients had free air under the armpits on the X-ray plain film, and sometimes visible fecal block shadows and calcified fecal shadows. Diagnostic abdominal wear helps to understand the nature of peritonitis, SP lacks specific clinical manifestations. Preoperative diagnosis rate is low, Serpell statistics is only 11%, the key to improve the preoperative diagnosis rate is to have a full understanding of the disease, Serpell proposed that when elderly patients with peritonitis have a history of chronic constipation, the abdomen can touch the mass, the abdomen When the X-ray film has the underlying free gas and the dung block shadow, it should be considered as a colonic fecal perforation.
Examine
Examination of colonic fecal perforation
1. Abdominal X-ray film.
2.CT.
3. Colonoscopy.
Diagnosis
Diagnosis and differentiation of colonic fecal perforation
diagnosis
It can be diagnosed based on medical history, clinical manifestations and laboratory tests.
Differential diagnosis
1. Acute peritonitis.
2. The small intestine ruptured.
3. Colon damage.
