small intestinal fistula
Introduction
Brief introduction of small intestine When there is an abnormal passage between the intestines and other hollow organs or between the body surface, it is intestinal fistula, and the small intestine occurs in the small intestine. The small intestine fistula can be divided into duodenal fistula according to which part of the small intestine is located. , jejunum and ileum. When the intestinal fistula is connected with other hollow organs such as the biliary tract, urinary tract, genital tract or other intestines, it is called internal hemorrhoid; on the contrary, if it is connected with the body surface, the external hemorrhoids, the duodenum and the ligament below the ligament are 100cm. The intestinal fistula is high in the sputum, and the ileum in the distal segment is low in the sputum. According to the amount of small intestinal sputum discharge, it can be divided into high flow enthalpy and low flow enthalpy. basic knowledge Sickness ratio: 0.0012% Susceptible people: no specific population Mode of infection: non-infectious Complications: sepsis shock gastrointestinal bleeding
Cause
Cause of small bowel fistula
There are many reasons for small bowel fistula, which can be roughly divided into surgery, injury, disease and congenital, etc. Most of them are caused by surgery.
(1) Surgery-induced surgery is the most common cause of small intestine fistula. Xiju Medical College reported that 95.1% of the small intestinal fistulas treated between 1957 and 1983 occurred after surgery. Roback et al reported 55 cases of high intestinal small intestine removal. For example, Crohn's disease complicated with intestinal aid occurs after surgery, and the causes of intestinal fistula after surgery are various.
(1) Gastrointestinal anastomotic leakage: It is a common cause of intestinal fistula. Many anastomotic leakage are due to operational technical disadvantages. For example, the diameter of the gastrointestinal tract at both ends of the anastomosis is too much, and the anastomosis is not uniform enough. There is a large pore in one place; the anastomosis is too dense or too sparse; the blood supply to the anastomosis is insufficient or the tension is too high; the intestinal wall of the anastomosis is edema, scar or cancer infiltration, and the distal intestine of the anastomosis after surgery Obstruction or poor proximal gastrointestinal tract decompression is also the cause of anastomotic leakage.
(2) Duodenal fistula: Due to only partial peritoneal covering, the duodenum is prone to sputum after anastomosis or suture. The sputum occurs at the stump closure or the incision of the intestine wall can be divided into ends. and lateral iliac crest, in which the loss of intestinal fluid is more severe with lateral sputum, and the prognosis is worse. The end sputum occurs after gastrectomy, or because of scar tissue at the stump, or due to insufficient blood supply, or improper suture operation. Such as excessive varus, excessive tension, etc., a large part of the lateral paralysis is formed after the duodenal Oddi's sphincter incision, or due to omission during the incision suture to produce duodenal posterior wall leakage, or Leakage due to excessive tension of the transverse wall after longitudinal sulcus of the duodenum; may also occur in the duodenum when right kidney resection or right colon surgery.
(3) Surgical injury: If the abdominal surgery is poorly exposed or extensive intestinal adhesion, or due to insufficient experience of the surgeon, the operation may cause damage to the intestinal wall or its blood supply and cause intestinal fistula, especially in the case of extensive intestinal adhesion surgery. It is most likely to damage the intestinal wall and requires special attention.
(4) After the operation, foreign matter such as gauze or drainage tube is left, and the steel wire suture is improperly placed: the gauze left in the abdominal cavity mostly causes intestinal perforation and abdominal abscess, abscess or self-piercing incision, or formation of external hemorrhoids after surgical drainage. Improper drainage tube after operation (the tube is too hard, the catheter is pressed against the intestinal wall) can be pressed, and the intestinal wall is worn to form an external hemorrhoid. After the operation, the abdominal wall should be carefully put into the drainage tube to avoid damage, and in addition, the abdominal cavity Negative pressure suction of the drainage tube may attract the intestinal wall, causing perforation of ischemic necrosis of the intestinal wall, which should be avoided. If it is necessary to continue vacuum suction, double cannula drainage should be used. Extraperitoneal, otherwise, when the intestine is excessively flattened, the wire is pressed against the intestinal wall and intestinal fistula occurs.
(B) traumatic abdomen sharp or blunt trauma may damage the intestinal tract into intestinal fistula, especially the duodenum of the part of the retroperitoneum, due to fixation and vulnerable to crush injury, intestinal perforation generally into the free abdominal cavity, Causes diffuse peritonitis; the posterior wall penetrates to form a retroperitoneal abscess, which can later break into the free abdominal cavity.
It has been reported that acupuncture treatment causes intestinal spasm, and radiation therapy may also damage the intestinal wall and cause paralysis.
(C) the disease caused by small appendicitis acute appendicitis after perforation often form appendix abscess, drainage often form appendix stump sputum, inflammatory bowel disease such as Crohn disease, intestinal tuberculosis and intestinal tumors can form intestinal perforation and intestinal fistula Inflammatory diseases such as Crohn's disease and abdominal abscess may cause guilt between different intestines. Another common internal hemorrhoid is gallbladder or internal fistula between the bile duct and the intestine, when the gallbladder occurs due to inflammation and duodenum. After adhesion, stones in the gallbladder can compress the gallbladder adhesion to cause ischemia, after necrosis become internal hemorrhoids (cabular duodenal fistula), gallbladder fistula can also pass into the stomach or colon, duodenal bulb ulcer can also be combined with gallbladder Or bile duct duodenal fistula, acute necrotizing pancreatitis with an abscess can also break into the intestine and form intestinal fistula.
(D) congenital anomalies of the yolk canal can cause congenital umbilical hernia.
The pathophysiology caused by small intestinal fistula may vary depending on the level of the sputum. Generally speaking, the physiological disturbance of the high intestinal fistula is lower than that of the sputum, and the following pathophysiological changes are generally observed.
(1) Dehydration and electrolytes, acid-salt balance disorder The daily gastrointestinal secretions of adults are estimated to be 7000-10,000 ml, most of which are re-absorbed in the proximal ileum and colon, so the upper part of the duodenum and jejunum The high intestinal small intestines lose more intestinal fluid per day, which can be as high as 7000ml. Therefore, if it is not timely replenished, it can quickly cause dehydration, low blood volume, peripheral circulatory failure, and shock.
In the same amount of water loss in the same fashion, there is electrolyte loss, depending on the location of the sputum. If the main loss of gastric juice, the loss of electrolyte is mainly H+ and Cl. For example, the loss of intestinal fluid is mainly Na+, K+ and HCO3. can lose 240g of NaCl every day. With the loss of electrolyte, it will affect the balance of acid and strontium. A large amount of sputum loss of intestinal fluid often causes metabolic acidosis. If it loses acidic gastric juice, it can produce low-potassium sputum poisoning.
The loss of water and electrolytes in the lower intestinal tract is less, such as the distal ileum, the daily fluid loss is only about 200ml, which rarely causes serious physiological disturbance.
The internal hemorrhoid between the high intestine and the colon will short-circuit a long segment of the intestine with important digestive and absorbing functions, which can cause severe diarrhea, which can also cause serious water and electrolyte disorders and nutritional disorders.
(2) Infection of a small number of small intestines is formed by non-healing of the surgical drainage, such as the duodenal or jejunostomy; other sputum is formed by the gradual penetration of the two hollow organs that have been adhered; These sputum are not accompanied by obvious local or systemic infections during the formation process. However, most of the intestinal fistulas are complicated by the formation or diffuse peritonitis, and abscesses, single or multiple, patients with fever, abdominal pain, bloating, stomach Intestinal dysfunction such as nausea, vomiting, anorexia, diarrhea or no defecation, weight loss, symptoms of poisoning, even sepsis, shock, death; can also cause stress ulcers, gastrointestinal bleeding, toxic hepatitis, ARDS, Renal failure and so on.
(3) Malnutrition With the loss of intestinal fluid, there is still a large loss of digestive enzymes and proteins, and the function of digestion and absorption is impaired, resulting in a negative nitrogen balance, vitamin deficiency, rapid weight loss, anemia, hypoproteinemia, and even evil. Liquid quality and death.
(4) Skin erosion around the mouth of the mouth Due to long-term erosion of the digestive juice, the skin around the mouth is prone to erosion. The patient complains of severe pain. Especially the high intestinal juice is rich in digestive enzymes, which is more likely to cause skin damage. Granulation tissue can also be eroded by the erosion of digestive juice.
(two) pathogenesis
1. Pathological physiology The local damage and systemic influence of small intestinal fistula are affected by many factors. The most important factors are the position of the sputum, the size of the flow and the patency of the drainage. After the small intestine occurs, the body may appear below. A series of pathophysiological changes.
(1) Body fluid, electrolyte disorder and acid-base imbalance: the daily gastrointestinal secretion of adults is 7000 ~ 8000ml, most of which are reabsorbed in the ileum and proximal colon, so the upper part of the duodenum and jejunum is small intestine The amount of intestinal fluid lost per day can be as high as several thousand milliliters. Therefore, if the patient fails to get timely and appropriate supplements, obvious dehydration and acid-base imbalance can occur soon, and severe circulation can lead to peripheral circulation and renal failure. Hypovolemic shock, or even death.
In the same fashion, the loss of electrolytes, the loss of electrolytes, depending on the location of the phlegm, such as the main loss of gastric juice, the electrolyte loss is mainly H+ and Cl-, such as loss of intestinal fluid, Na+, K+ and HCO3- For many, with the loss of electrolyte will inevitably affect the acid-base balance, the loss of a large amount of alkaline intestinal fluid will cause metabolic acidosis, such as the main loss of acidic gastric juice will produce hypokale alkalosis.
In the low intestinal sputum, the electrolyte loses less. For example, the distal ileal sputum loses about 200ml per day, which rarely causes serious physiological disturbances. Therefore, it has little effect on the whole body, and it can maintain balance after proper supplementation.
The internal hemorrhoid between the high intestine and the colon causes a long segment of the intestine with important digestive and absorbing functions to produce severe diarrhea and water, electrolyte imbalance and nutritional disorders.
(2) Infection: After the occurrence of intestinal fistula, the intestinal contents flow into the abdominal cavity, often causing acute diffuse peritonitis. If not drained in time, it may cause toxic shock, even in a short period of time, such as the lower position of the fistula, the mouthwash Small, low flow, it can cause localized peritonitis, and then develop into abdominal abscess. After the abscess is worn out, it can form extraintestinal fistula. If the drainage is not timely or not smooth, the infection can continue to worsen and develop into sepsis. Aggressive ulcer bleeding, impaired liver function, ARDS and multiple organ failure, peritonitis and abdominal abscess are the most important pathological lesions in the early stage of intestinal fistula. Early detection and timely and effective drainage are extremely important and can interrupt their development for further treatment. Provide favorable conditions.
(3) Malnutrition: Due to the loss of a large amount of digestive enzymes in the sputum, not only the intestinal digestion and absorption function is seriously impaired, but also a large amount of protein is lost, and patients with intestinal fistula often cannot eat, thus inevitably causing significant negative nitrogen. Balance, different degrees of malnutrition, rapid decline in body weight, anemia, hypoproteinemia, organ atrophy, not only poor wound healing, but also serious infection due to low immune function, excessive consumption eventually leads to cachexia and death, this kind of death The change in the lower position of the small intestine is prominent.
(4) Skin erosion around the mouth: It is digested and corroded by enzymes in the digestive juice. The skin around the mouth often has flushing and varying degrees of erosion. The range is gradually enlarged, it is difficult to control and treat, and the pain is severe and unbearable. Eczema and dermatitis may occur in the skin around the mouth, or soft tissue infections such as bloating and cellulitis may occur.
(5) pathological changes of intestinal fistula: the development of intestinal fistula and its final outcome are always closely related to the pathological condition of the intestine and adjacent tissue in the site of intestinal fistula. In the early stage, the intestinal tube near the intestinal fistula has edema and inflammation. And often accompanied by the corresponding dysmotility, resulting in the retention of intestinal contents and increased intestinal pressure, so that the mouth continues to increase, the sputum also increased, after other treatments such as drainage and anti-infection, the intestinal wall and surrounding The inflammation and edema of the tissue gradually subsided, the patency of the intestinal tract was restored, the mouthwash was also reduced, the outflow began to decrease, the adhesion around the intestinal fistula, the granulation tissue proliferated to form a tubular tendon, and finally the fistula was filled with granulation tissue and formed a fibrous scar. Healing, this is the process in which the small intestine sputum grows from small to large, and then properly healed and then healed from large to small.
Some of the sputum can not be healed naturally, and further surgery is needed. In order to facilitate the clinical treatment, according to the systemic and local pathological changes of intestinal fistula, the whole pathological process can be divided into three stages:
The first stage: from the occurrence of intestinal fistula to stable condition, usually 2 to 3 weeks, the main contradiction in this stage is peritonitis, abdominal abscess and water caused by the loss of a large amount of intestinal fluid, electrolyte imbalance, in the treatment should be directed to the above Several contradictions have taken active and effective measures to strive to stabilize the condition as soon as possible.
The second stage: peritonitis has been controlled, the abscess has been drained, the loss of intestinal fluid begins to decrease, and the condition is relatively stable. As the disease period prolongs, the nutritional problem will turn into a major contradiction. It should reduce the loss of intestinal fluid, supplement nutrition, and promote The reduction of intestinal fistula and wound healing are important. If this stage is prolonged, other complications can still occur, and even the patient will die and die.
The third stage: the whole body condition turns from stable to better, the body weight begins to increase, and the part of the mouth gradually shrinks with the proliferation of granulation tissue and the formation of scars. Most of the tubular tendons can be closed by themselves, and the tubular sputum and lip sputum which cannot be closed by themselves It also has the conditions for surgical repair, and can be surgically selected after necessary preparation.
2. Classification of intestinal fistulas can be carried out from different angles. The commonly used classification methods are as follows:
(1) According to the cause classification: it can be divided into three types: injury, inflammation and tumor.
(2) According to the classification of anatomical parts: according to the original part of the sputum, such as duodenal fistula, jejunum fistula, ileum fistula and colon fistula, etc., some people put the duodenum and duodenal suspensory ligament below 100cm range The intestinal fistula is called high intestinal fistula, and the distal ileal fistula is called low intestinal fistula. This classification mainly focuses on the nature and extent of water and electrolyte imbalance that may be caused, which is convenient for guiding clinical treatment.
(3) According to the classification of intestinal fistula and skin: it can be divided into indirect (also known as complexity) and direct (also known as simple), usually indirect intestine in the initial stage of sputum, the contents of the intestine gather in somewhere in the abdominal cavity and indirectly drained to the abdomen. This intestinal fistula is the most harmful to the patient.
(4) According to the morphological classification of sputum: it can be divided into lip sputum and tubular sputum. The former refers to the partial valgus of the intestinal mucosa and the lip shape of the skin. The sputum can not be self-healing, but the latter is not. This classification has certain guiding significance for treatment.
(5) According to the intestinal fistula occurring in the side of the intestine or the end of the classification: can be divided into lateral and terminal sputum, the lateral sputum lost intestinal fluid is more serious, the prognosis is also poor.
(6) According to the outflow volume of the mouthwash within 24 hours on an empty stomach: it can be divided into two types: high flow rate and low flow rate. Generally, it is called high-flow intestinal fistula which discharges more than 1000 ml of intestinal fluid through the fistula within 24 hours.
(7) According to the number of sputum classification: can be divided into single-shot and multiple-type, these classifications are proposed from a certain side, the purpose is to make an estimate of all aspects of sputum, in order to guide clinical treatment, Therefore, after the occurrence of intestinal fistula, after a period of emergency treatment, it is necessary to make qualitative, localized and quantitative diagnosis of the intestinal fistula that has occurred as much as possible, and to synthesize the above various classifications and make a comprehensive comprehensive judgment in order to better arrange Treatment plan.
Prevention
Small bowel prevention
Most of the small intestine fistula occurs in abdominal surgery. The main reason is the organic environment, nutritional status and immune function. In addition to the urgent need for emergency surgery, adequate preoperative preparation should be done for elective surgery to correct water and electrolyte disorders and improve nutrition. Controlling infections will effectively reduce the incidence of intestinal cramps.
For a wide range of abdominal adhesion surgery, the operation should be patient and meticulous, reduce the damage of the intestinal wall, the rupture of the small muscle layer of the small area should be repaired, the damage range is large and the affected intestinal segment is not long, and the adhesion of the intestinal segment can be considered. Surgical indications for inflammatory bowel obstruction should be strictly controlled.
Anastomotic rupture is one of the main causes of intestinal fistula formation. There are many reasons for intestinal fistula caused by rupture of anastomotic stoma. Anastomosis technique is the key. Suture overdensity leads to local tissue ischemia and poor healing. Suture can cause anastomosis. Leakage, effective postoperative gastrointestinal decompression is an effective measure to prevent anastomotic leakage. Control of intra-abdominal infection is an essential factor to ensure good healing of the anastomosis. The necessary abdominal drainage is also important.
Complication
Complications of small intestine Complications septic shock gastrointestinal bleeding
Small intestines lose more intestinal fluid per day. If they are not replenished in time, they can quickly cause dehydration, hypovolemia, peripheral circulatory failure, shock and other complications.
Small intestinal fistula causes gastrointestinal dysfunction, may occur diarrhea or no defecation, weight loss, poisoning symptoms, even sepsis, shock, death; may also be complicated by stress ulcers, gastrointestinal bleeding, toxic hepatitis, ARDS, kidney Functional failure, etc.
Symptom
Symptoms of small intestine fistula Common symptoms Peritonitis nausea Abdominal tenderness Urgent after heavy abdominal infection Infection Abdominal sepsis Abdominal pain Intestinal paralysis was thin
A typical example is a patient who has 2 to 7 days after gastrointestinal surgery. After successful recovery, the body temperature continues to be above 38 °C, and the heart rate exceeds 100 beats per minute. The general complaints, abdominal distension, and gastrointestinal function are not restored. It is characterized by nausea, vomiting, no exhaustion of bowel movements or increased stool frequency. It is a watery sample, and the amount is small. It is still discomfort after abdominal discomfort. When physical examination, there is abdominal restriction or diffuse tenderness except abdominal distension, but generally no muscle. Tonic, the above is abdominal infection, peritonitis, abdominal abscess, intestinal paralysis, if not diagnosed in time, redness and swelling appear in the incision, immediately through the discharge of a lot of purulent fluid, initially purulent, followed by pus, 1 After 2 days, it is the contents of the intestine. According to the position of the sputum, the amount and nature of the leakage are different: the high intestinal small sputum loses a lot of liquid and is thin, containing bile and pancreatic juice; the lower sputum leaks less liquid and is thicker, high Or when there is obstruction on the distal side, there is a large amount of fluid loss, which can cause severe dehydration and electrolyte imbalance. Most intestinal fistulas are accompanied by one or more abscesses. After drainage, the general drainage is still unsmooth, and the nutritional supplement is difficult. The patient is very Fast weight loss, malnutrition, can be associated with persistent sepsis and sepsis, multiple organ failure and death, such as intestinal sputum circulation, abdominal infection can be controlled, the patient generally improves, and the mouth is not cured for a long time, still acceptable Causes skin around the skin to smash.
The clinical manifestations of small intestinal fistula vary from site to site and from disease to disease, and different stages of sputum formation also have different manifestations.
Generally 2 to 7 days after gastrointestinal surgery, the patient complained of discomfort, abdominal distension, gastrointestinal function not recovered, body temperature continued above 38 ° C, pulse >100 times per minute, white blood cell count increased, manifested as nausea, vomiting, no anus Defecation, venting, or stool frequency increased, but the amount is small, the water sample is loose, after the relief, the abdominal discomfort is still felt, the abdominal signs are abdominal infection, peritonitis, intestinal paralysis, abdominal incision redness, is a typical wound infection, When the incision is worn, the pus and bloody fluid can be discharged. After 24 to 48 hours, a large amount of fluid, that is, intestinal fluid, flows out. After drainage, the symptoms such as fever and white blood cell count can be improved.
Due to the loss of a large amount of intestinal fluid, it can cause severe water, electrolyte imbalance, even hypovolemic shock, patients can not eat, and nutritional supplements are difficult, and soon weight loss, weight loss, manifestations of malnutrition, patients can be concurrent Sepsis and/or sepsis, resulting in multiple organ failure and death, such as smooth circulation, infection control, general improvement, and timely and effective nutrition, mouth can be closed.
In addition, since a large amount of intestinal fluid flows out from the mouth, the skin around the mouth is often flushed, eroded, and eczema-like.
The amount of drainage is very valuable for estimating the position of the sputum. Generally speaking, the high intestinal small sputum has a large amount of drainage and is thin, containing bile and pancreatic juice, while the lower intestinal tract has less drainage and thicker, and the incision fascia. The ruptured drainage fluid is clearer and occurs more often 2 to 5 days after surgery. Therefore, the time of occurrence helps to identify the incision fascia rupture or early intestinal rupture.
After abdominal trauma or surgery, the possibility of intestinal fistula should be considered when the following conditions occur:
1 abdominal incision or wound and/or drainage tube has a continuous amount of exudate,
2 Bile-like liquid appears from the incision or drainage tube, and the gas is discharged or the fecal-like liquid is drained.
3 sustained diaphragmatic stimulation (such as hiccups), pelvic stimulation (such as urgency) or signs of peritonitis,
4 There were unexplained persistent fever and abdominal pain after surgery.
It should be pointed out that when there are symptoms and signs of peritoneal inflammation after surgery, the possibility of intestinal fistula should be considered. The response of patients after abdominal surgery to abdominal infection is different from that of normal people. Abdominal pain and abdominal muscle contraction are all significantly weakened. Therefore, For a patient with a continuous body temperature above 38 °C, pulse 100 times per minute, only patients with abdominal distension without obvious abdominal pain, and no abdominal muscle rigidity, should be alert to the possibility of peritonitis, B-ultrasound, abdominal X-ray Photographic and diagnostic abdominal puncture often have a positive finding. If necessary, the test can be repeated. If the external hemorrhoids cannot be completed, the diagnosis is not difficult. However, in order to confirm the diagnosis and further understand the pathology, the following tests can be performed.
(1) Oral dye test: It is the easiest and most practical method to give patients oral dyes such as methylene blue, bone charcoal, Congo red or rouge, etc., to observe whether there is dye discharge from the mouth, and to estimate the location of the sputum according to the time of discharge. The number of dyes discharged can also be used as a factor in estimating the size of the mouth.
(2) fistula angiography: a more reliable and more direct method of examination, insert a thin plastic catheter from the fistula, the mouth is marked with metal, a contrast agent such as diatrizoate, 12.5% sodium iodide or Iodine oil, etc., while observing the direction of the contrast agent on the fluorescent screen, at this time, the catheter insertion depth, the amount of contrast agent injection and the patient's body position can be adjusted, and the appropriate time film can be selected, and the film can be repeated after a few minutes, so as to understand The length of the fistula, to which part of the intestine, to the presence or absence of abscess.
(3) gastrointestinal barium meal angiography: can also show the location of intestinal fistula, but because the tincture is thicker than the water-soluble contrast agent, it is difficult to completely display the entire fistula and abscess, but can observe the presence or absence of distal intestinal obstruction, On the other hand, the small intestine fistula can not be used for the above-mentioned fistula angiography and other examinations, gastrointestinal barium meal examination has become the main diagnostic test, such as suspected colonic fistula can also be used as a barium enema examination, such as biliary intestinal fistula, abdomen The flat film can be seen in the biliary tract gas development, and the barium can be seen through the gastrointestinal tract into the gallbladder or bile duct to confirm the diagnosis.
The clinical manifestations of small intestine fistula vary from site to site and from disease to disease, and different stages of intestinal fistula formation also have different manifestations. The most common abdominal bowel fistula after abdominal surgery is introduced as an example.
Full exclusion of intestinal fistula diagnosis, can be fasted first, placed gastrointestinal decompression.
Examine
Examination of small intestine fistula
1. Oral dye test is the most simple and practical method, give patients oral non-absorbed dyes, such as methylene blue, bone charcoal, Congo red or rouge, etc., observe whether the dye is discharged from the mouth, and based on the time of discharge The height of the sputum can be used as a factor in estimating the size of the sputum.
2. Sputum angiography is a more reliable and direct method of examination, inserting a thin plastic catheter from the fistula, using a metal object as a marker, and injecting a contrast agent such as diatrizoate from the catheter, 12.5% sodium iodide or lipiodol Etc. At the same time, observe the trend of the contrast agent on the fluorescent screen. At this time, the insertion depth of the tube can be adjusted, the amount of contrast agent injected and the position of the patient can be selected, and the appropriate time can be selected, and the film can be repeated after a few minutes to understand the fistula. Length, which path to the intestine, whether there is abscess or not.
3. Gastrointestinal barium angiography can also show the location of intestinal fistula, but because the barium is thicker than the water-soluble contrast agent, it is difficult to completely display the entire fistula and abscess, but can observe the presence or absence of distal intestinal obstruction. On the one hand, the small intestine fistula can not be used for the above-mentioned fistula angiography and other examinations, gastrointestinal barium meal examination has become the main diagnostic test, such as suspected colonic fistula can also be used as a barium enema examination, such as biliary intestinal fistula, abdominal flat The film can be seen in the biliary gas development, and the barium can be seen through the gastrointestinal tract into the gallbladder or bile duct to confirm the diagnosis.
4. CT, B-ultrasound B-ultrasound is conducive to the localization diagnosis of abdominal abscess, the abscess in the concealed part of the intestines is affected by the accumulation of gas in the intestine, and the abdominal CT examination helps diagnosis.
Diagnosis
Diagnosis and identification of small intestine
Gastrointestinal surgery or abdominal trauma from the incision or wound continued to flow out of the intestinal contents suggesting the presence of intestinal fistula, such as surgery or injury after the occurrence of peritonitis symptoms and signs should also first consider the possibility of intestinal fistula should be diagnosed and Treatment, sometimes inexperienced surgeons face a fever 38 ° C, pulse rate of 100 beats / min, abdominal distension, abdominal tenderness, postoperative patients often because of their lack of complaints of abdominal pain, fever is not too high, no abdominal muscle rigidity and hesitation Unresolved, delaying the diagnosis of the opportunity and causing death, in fact, the patient's response to abdominal infection after abdominal surgery is different from normal people, fever, abdominal pain, abdominal muscle contraction and other reactions are significantly weakened, this should be noted, encountered Such cases should be examined by B-ultrasound and abdominal radiography to observe whether there is abdominal cavity or underarm abscess or free blood under the armpit. If there is a positive finding, it should be drained; even if there is no positive result, it can not be excluded. It can be used for abdominal puncture to confirm the clinical. Diagnose and repeat the above checks if necessary.
Different from small intestine injury, the intestinal contents are continuously discharged from the incision or wound after gastrointestinal surgery or abdominal trauma.
