Colon damage
Introduction
Introduction to colon injury Injury of Colon is a common cavity organ injury caused by blunt abdominal injury and penetrating injury. It can also be caused by iatrogenic injury such as barium enema or colonoscopy. Perforation, etc. Because there are more bacteria in the colon, the peritonitis is serious, the symptoms of systemic poisoning are heavier, and often life-threatening. Some parts of the colon are extraperitoneal. When the injury occurs, the peritonitis is not easily missed. The abdominal injury is often multiple organs, multiple segments of intestinal damage, peritonitis. Obviously, it is easy to cover up the colon damage caused by misdiagnosis or missed diagnosis, should pay attention. basic knowledge The proportion of patients: the incidence of abdominal trauma patients is about 1-2% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia
Cause
Cause of colon injury
The cause of colon injury is divided into three aspects
Blunt damage (20%):
When a closed abdominal injury caused by a traffic accident, earthquake or house collapse, the force directly on the spine may cause a transverse colon fracture; or because the colon wall is thin, the tension is large, the extruded bow is ruptured; or the blood vessel involving the mesenteric artery is damaged. Cause colon necrosis and so on.
Iatrogenic injury (20%):
In the case of sigmoidoscopy or fiberoptic colonoscopy, the perforation of the colon may be caused by improper operation; or the perforation of the colon may cause rupture of the colon, and the double-pressure contrast angiography of the barium enema or sputum may cause the intussusception to be reset. Colonic rupture and perforation; colon damage due to surgical damage to the intestinal wall and mesentery.
Colonic damage usually accounts for 10% to 20% of abdominal injuries, more wartime, more complications after colon injury surgery, and correspondingly higher mortality.
In the case of colon injury, the lamella layer is ruptured, the sarcolemma ruptures and the entire wall of the intestinal rupture and even rupture; the contusion of the intestinal wall has a subserosal hematoma and hematoma in the intestinal wall; if the mesangial injury, there is arteriovenous rupture, or Vascular thrombosis causes delayed intestinal necrosis.
When the colon wall is completely ruptured or necrotic and perforated, the colon contents (feces) overflow into the abdominal cavity, diffuse peritonitis occurs, and if there is adhesion, localized peritonitis can be formed, occasionally due to small perforation, and fecal slag is blocked and healed, colon contents Neutral to the peritoneal irritation is small, early peritonitis is not obvious, easy to misdiagnosis, late local pollution is serious (the most bacteria in the feces), plus the colon has ileocecal valve and anal sphincter both ends "closed", so that the intestinal pressure is increased The intestinal contents are overflowing a lot, causing serious infection of the abdominal cavity, serious symptoms of systemic toxicity, and even death. The colon wall is thin and the blood circulation is poor. Therefore, the healing ability of the colon is ruptured and sutured, and it is easy to form intestinal fistula. It is a common concomitant disease. disease.
Penetrating injury (20%):
Most common, usually seen in peacetime and wartime, such as knives, scissors and sharps, stab wounds, explosions and bullet wounds, etc., caused by open abdominal injuries, can cause different degrees of colon damage.
Prevention
Colon injury prevention
No specific precautions, pay attention to avoid trauma. In the case of abdominal trauma, the colonic rectal injury is guarded, and early treatment is found early to prevent complications.
Complication
Colonic injury complications Complications anemia
1. Anemia.
2. Secondary infection.
Symptom
Colonic injury symptoms Common symptoms Toxic megacolon peritoneal irritation peritonitis nausea abdominal pain mobile dullness abdominal tenderness pneumoperitoneum bowel tension
Have a history of abdominal trauma, generally have a history of abdominal pain, often accompanied by nausea, vomiting and bloody stools, colonic extraperitoneal injury rupture and delayed intestinal necrosis, the symptoms appear later, if there is a combined injury, may be due to serious injuries Cover up local symptoms.
The most prominent signs are total abdominal tenderness, rebound tenderness and muscle tension, which is most obvious in the lesions. It can cause peritoneal irritation due to the size of the rupture of the colon or the amount of spillage during the transection, the type of bacteria and the time of treatment. The weight is also different, the mobile voiced sound can be positive, and the bowel sounds disappear.
Examine
Colon damage examination
1, X-ray inspection
Abdominal plain film or fluoroscopy found that there is free gas under the armpit or gas accumulation after the peritoneum, and the abdominal intestine is generally flatulent or has a liquid-air plane to determine whether there is damage to the hollow organ, according to the site to determine whether there is colon rupture, abdomen Plain films can also be found in fractures and metal foreign bodies.
2, abdominal diagnostic puncture (referred to as abdominal wear)
According to the extracted liquid, if the stool-like substance is intestinal damage, the blood that is not coagulated may be a substantial organ injury, and the diagnostic puncture is performed: the acupuncture needle is used, the needle core is taken out, the catheter is inserted, and the suction is performed. Liquid test, such as pumping out liquid, can be injected into the abdominal cavity via the catheter, lactated Ringer's solution or isotonic saline (10 ~ 20ml / kg), lavage fluid recovery, according to visual observation and laboratory tests, in line with any of the following The item is positive: 1 the rinse liquid contains macroscopic blood, bile, gastrointestinal contents or urine; 2 microscopic examination of red blood cell count is greater than 0.12 × 1012 / L; 3 amylase exceeds 1000 u / L (Soxhlet method); 4 lavage microscopic examination found a large number of bacteria, this method is more reliable than diagnostic puncture, the diagnostic accuracy rate reached 98.1%, minimal complications.
The false positive rate of diagnostic abdominal puncture or lavage is about 2% to 3%, more common in: 1 pelvic or spinal fracture, peritoneal bone pierced by the bone tip, blood flow into the abdominal cavity; 2 lower abdominal retroperitoneal hematoma, resulting in false puncture Into the hematoma area, learn the less than a bloody fluid, the relative contraindications are: 1 severe abdominal distension or intestinal paralysis; 2 history of extensive intestinal adhesions or multiple abdominal surgery; 3 pregnant, late patients.
3, laparoscopy
In recent years, fiber laparoscopy has been widely used, and the early diagnosis rate of abdominal injury has been continuously improved.
4, CT examination and B-mode ultrasound examination
It has a high diagnostic rate for solid organ damage, and can provide a reference for the damage of hollow organs, especially for the diagnosis of concurrent abdominal effusion and abscess.
Diagnosis
Diagnosis of colon injury
diagnosis
According to the signs of abdominal pain, nausea, vomiting and peritonitis after abdominal trauma, X-ray showed pneumoperitoneum and diagnostic puncture to extract fecal-like fluid to determine colonic injury.
Differential diagnosis
It is distinguished from other organ damage caused by abdominal trauma.
